{ "schemaVersion": "deck-intelligence.v1", "id": "019dd923-5ca1-7489-b639-45501f4b359b", "slug": "158df8627a0b9aca", "title": "Opioid Conflicts Majority Staff Report", "subtitle": "U.S. House Committee on Oversight and Reform", "author": "U.S. House Committee on Oversight and Reform", "pageCount": 53, "kind": "consulting-deck", "orientation": "portrait", "aspectRatio": 0.773, "document": { "id": "019dd923-5ca1-7489-b639-45501f4b359b", "slug": "158df8627a0b9aca", "title": "Opioid Conflicts Majority Staff Report", "rawTitle": "Opioid Conflicts Majority Staff Report", "authorId": "McKinsey", "authorName": "U.S. House Committee on Oversight and Reform", "authorDisplay": "U.S. House Committee on Oversight and Reform", "kind": { "slug": "consulting-deck", "label": "Consulting deck" }, "sourceType": { "slug": "strategy_consulting", "label": "Strategy consulting" }, "fileName": "2022-Opioid-Conflicts-Majority-Staff-Report.pdf", "sourceUrl": "https://oversightdemocrats.house.gov/imo/media/doc/2022-04-13.McKinsey%20Opioid%20Conflicts%20Majority%20Staff%20Report%20FINAL.pdf", "sourceDate": "2022-04-13 00:00:00", "presentationDate": null, "ingestedAt": "2026-04-23 20:51:40+00", "status": "ready", "pageCount": 53, "orientation": "portrait", "aspectRatio": 0.773, "targetCompany": null, "targetTicker": null, "metadata": { "local_root": "/tmp/legacy-images/158df8627a0b9aca", "origin_corpus": "consulting" } }, "coverage": { "pageCount": 53, "pagesIndexed": 53, "pagesWithImages": 53, "pagesWithMetadata": 53, "imageCoveragePct": 100, "metadataCoveragePct": 100, "componentCount": 364, "chartCount": 1, "metricSlides": 4, "toolMatches": 4, "documentToolMatches": 0, "frameworkMatches": 1, "arcMatches": 1, "beatMatches": 3, "loopMatches": 2, "patternMatches": 0, "storymakersMatch": false, "scoreAvailable": true, "reviewAvailable": true, "activistThesisAvailable": false, "pitchdeckMetadataAvailable": false, "pitchdeckProfileAvailable": false }, "blocks": [], "matches": { "arcs": [ { "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null, "categoryName": "Strategy & Business", "categorySlug": "strategy-business" }, "matchId": "de285613-74cb-4055-aa43-017716798b85", "evidence": "The document follows a clear problem-agitate-solution structure, presenting the problem of McKinsey's conflicts of interest, agitating it through detailed examples, and implying a solution through conclusions and recommendations.", "isPrimary": true, "confidence": 0.8, "extraction": { "at": "2026-07-16 21:07:34.358621+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "beats": [ { "to": 5, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null, "categoryName": "Strategy & Business", "categorySlug": "strategy-business" }, "from": 1, "name": "Problem & Complication", "beatId": "879d5693-fa0d-471e-8bc6-dddb3a68ee78", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Problem & Complication", "slug": "consultants-gambit-problem-complication", "status": "active", "canonId": "019dd9b8-064a-777f-a374-e9a8c43dedd4", "version": 1, "description": null }, "evidence": "The document introduces the problem of McKinsey's conflicts of interest and complicates it through examples of overlapping work.", "position": 0, "isPrimaryArc": true, "parentBeatType": { "name": "Complication", "slug": "complication", "status": "active", "canonId": "019dd9b8-0275-7709-b2d6-4f77c3fc7579", "version": 1, "description": "The point in the narrative where the audience should feel discomfort. Required for argumentative arcs." }, "alignedBlockIds": null, "matchConfidence": 0.8 }, { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null, "categoryName": "Strategy & Business", "categorySlug": "strategy-business" }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 }, { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null, "categoryName": "Strategy & Business", "categorySlug": "strategy-business" }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null, "categoryName": "Urgency", "categorySlug": "urgency" }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } }, { "to": 40, "from": 24, "loop": { "name": "51_voice_of_customer", "slug": "51-voice-of-customer", "status": "active", "bestFor": "Product strategy, customer experience, market research", "canonId": "019dd956-7aaf-750b-950b-af0df38f5266", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "What Customers Say (Verbatim) -> The Pattern Across Voices -> The Insight -> The Response", "description": "Let customer quotes and feedback drive the narrative and validate the insight", "familyLabel": null, "categoryName": "Validation", "categorySlug": "validation" }, "matchId": "308c22ef-34f3-45b8-b50d-c273c6edeb88", "evidence": "The document presents the concerns of regulatory bodies through examples of McKinsey's actions and lack of disclosure.", "position": 1, "objective": "What are the concerns of regulatory bodies regarding McKinsey's conflicts of interest?", "confidence": 0.6, "extraction": { "at": "2026-07-16 21:07:34.52569+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "tools": [ { "tool": { "name": "Executive summary", "slug": "executive-summary", "status": "active", "bestFor": null, "canonId": "019dd9e1-4b63-72d5-9734-da757d91ca61", "version": 1, "bodyDocId": null, "description": "A condensed view of the entire argument on a single slide / block.", "familyLabel": null, "categoryName": null, "categorySlug": null }, "agent": null, "layer": "slide", "agents": null, "matchId": "5846591a-8abf-40ca-8bc3-bcb6240ea0a9", "evidence": "This interim staff report presents preliminary findings from the Committee's investigation into McKinsey & Company's (McKinsey) consulting services for opioid and pharmaceutical companies and McKinse", "pageRefs": null, "priority": null, "whenToUse": null, "confidence": 0.9, "extraction": { "at": "2026-07-17 03:16:17.019916+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 3, "whyItWorks": null, "antipattern": null, "cardinality": "common", "narrativePurpose": null }, { "tool": { "name": "Audience Definition", "slug": "audience-definition", "status": "active", "bestFor": null, "canonId": "019dd956-7f2a-775d-aeee-ff099bcb7756", "version": 1, "bodyDocId": null, "description": "Six key questions: Who are they? What do they know? What do they believe? What do they care about? What do they fear? What decisions can they make?", "familyLabel": null, "categoryName": "Block", "categorySlug": "block" }, "agent": "Storyteller", "layer": "slide", "agents": [ "Storyteller" ], "matchId": "6847df5a-d81e-49f9-b2b2-7891fc12c2bb", "evidence": "The Committee’s investigation has uncovered evidence that McKinsey consultants advised FDA on opioid-related regulatory matters at the same time they were advising Purdue and other opioid manufacturers on sales", "pageRefs": null, "priority": "Core", "whenToUse": null, "confidence": 0.7, "extraction": { "at": "2026-07-17 03:16:17.186547+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 7, "whyItWorks": null, "antipattern": null, "cardinality": null, "narrativePurpose": null }, { "tool": { "name": "List presentation", "slug": "list-presentation", "status": "active", "bestFor": null, "canonId": "019dd9e1-4ef7-777d-ba68-9074c2b3bcf1", "version": 1, "bodyDocId": null, "description": "Bulleted, numbered, or checklist enumerations.", "familyLabel": null, "categoryName": null, "categorySlug": null }, "agent": null, "layer": "slide", "agents": null, "matchId": "5abf7d55-d5e6-487b-bacf-e9bead3b0544", "evidence": "From 2008 to 2022, McKinsey performed on 76 contracts for the FDA. FDA has paid McKinsey more than $140 million since 2008, including $40 million from CDER, which oversees opioid-related programs.", "pageRefs": null, "priority": null, "whenToUse": null, "confidence": 0.8, "extraction": { "at": "2026-07-17 03:16:17.255698+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 8, "whyItWorks": null, "antipattern": null, "cardinality": "common", "narrativePurpose": null }, { "tool": { "name": "Process flow", "slug": "process-flow", "status": "active", "bestFor": null, "canonId": "019dd9e1-4dca-76bc-8135-401836a1c4c0", "version": 1, "bodyDocId": null, "description": "Workflow, steps, sequential diagram.", "familyLabel": null, "categoryName": null, "categorySlug": null }, "agent": null, "layer": "slide", "agents": null, "matchId": "d44cb24d-2475-4a54-b3e8-85f4b917ad49", "evidence": "Flowchart showing FDA Scientist Safety Reviewers, Sentinel Lead Teams, MSOC, and Data Partner interactions.", "pageRefs": null, "priority": null, "whenToUse": null, "confidence": 0.7, "extraction": { "at": "2026-07-16 21:17:55.62966+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 24, "whyItWorks": null, "antipattern": null, "cardinality": "common", "narrativePurpose": null } ], "frameworks": [ { "matchId": "c7354210-1e86-4b62-bf44-d17c15978f6a", "evidence": "Timeline visualization of overlapping project durations", "framework": null, "confidence": 0.9, "extraction": { "at": "2026-05-02 19:14:37.421+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 19, "frameworkName": "gantt-chart" } ], "patterns": [] }, "storymakers": null, "score": { "backend": "claude", "scoredAt": "2026-05-02 07:21:30.902+00", "subScores": { "scqa_arc": 55, "action_titles": 70, "mece_structure": 72, "closing_strength": 50, "evidence_quality": 92, "clarity_of_thesis": 78, "production_quality": 55, "visual_storytelling": 28 }, "totalScore": 63, "coveragePct": 100, "explanations": { "scqa_arc": "Situation and Complication are well-framed (slides 3-7), but no explicit Question is posed and the Answer/recommendation is left implicit, so the deck reads as an evidentiary dump rather than a resolved arc.", "action_titles": "Roughly 20 slides carry full insight-bearing action titles, e.g. slide 5 'McKinsey failed to disclose its serious, longstanding conflicts of interests to FDA, potentially violating contract requirements and federal law', but many pages still use topic labels ('I. INTRODUCTION', 'Navjot Singh', bare page numbers).", "mece_structure": "Roman-numeral structure (I Introduction, II Findings A-E, III Conclusion) is largely MECE, though case-study slides 9-15 and 19-23 revisit the same consultants and overlap themes.", "closing_strength": "Slide 52 ('III. CONCLUSION') and slide 53 summarize findings but stop short of concrete recommendations, regulatory asks, or a numbered call-to-action; the closing trails off mid-sentence on slide 53.", "evidence_quality": "Exceptional - nearly every claim is anchored to specific internal McKinsey emails, named partners, contract numbers ($3.9M Sentinel, 37 FDA contracts, 22 consultants) and footnoted document IDs.", "clarity_of_thesis": "Central thesis (McKinsey advised FDA and opioid manufacturers concurrently, undisclosed) is declared in the executive summary on slide 3 and reinforced as action titles on slides 4-5.", "production_quality": "Footnote discipline is excellent and section numbering is consistent, but density skews dense/overcrowded (slide 47), action-title coverage is uneven, and whitespace is minimal across all 53 pages.", "visual_storytelling": "Almost every slide is dense narrative prose; only slide 16 (comparison table), slide 19 (timeline) and a handful of email screenshots (24, 31, 41, 46, 47, 52) use the right visual tool for the message." }, "slidesAnalyzed": 53 }, "review": { "backend": null, "verdict": "An investigative report dressed as a deck: opens like a Storymakers exemplar with a thesis-first lead and quantified action titles, but the case-study middle reverts to topic labels and the close diagnoses without prescribing — useful as a teaching example for opening slides and quote-driven evidence, not for full-arc structure.", "reviewedAt": "2026-04-25 03:35:00+00", "slidesSeen": 53, "suggestions": [ "Rewrite the consultant-profile titles (p.9-15) into action statements naming the conflict (e.g. 'Jeff Smith staffed 28 of 37 FDA contracts while advising Purdue')", "Add a 'So what / Recommendations' act before the conclusion: 2-3 slides with explicit asks (FAR amendments, contract debarment review, disclosure rules) so the closing pays off the analysis", "Insert full-page MECE dividers for the four pillars implicit in the report — Cross-Staffing · Government-to-Private Business Development · Disclosure Failures · Policy Influence & Document Destruction — to replace the inline Roman-numeral nesting" ], "closingScore": 55, "openingScore": 82, "topStrengths": [ "Front-loaded thesis: p.4-5 deliver the two core accusations as full-sentence action titles before any evidence", "Quantified anchors woven into titles and callouts (22 consultants p.3/p.7, $3.9M Sentinel spend p.22, $1.1B 'FDA Conversion' value p.44) give the narrative numerical spine", "Direct-quote callouts ('Turbocharge Purdue's Sales Engine' p.12, 'necessary to save the business' p.20, document-destruction emails p.50-51) function as Storymakers pull-quotes that argue the thesis" ], "topWeaknesses": [ "Person-name section titles (p.9-15) bury the insight — readers cannot tell from the title why each consultant matters", "Eight slides surface as just a numeral (p.18, 28, 35, 36, 42, 43, 49, 51), suggesting the inventory missed real titles or these pages are visual-only — either way they break narrative flow", "Closing acts (p.52-53) restate the problem but issue no concrete recommendation, regulatory ask, or referral — the deck diagnoses without prescribing" ], "narrativeScore": 72, "pillarCritique": "Pillars exist as inline numbered headings (I. Introduction p.6, ii. FDA Sentinel p.21, iv. FDA Office of New Drugs p.27, 3. No Evidence of Disclosure p.38, E. Document Destruction p.50, III. Conclusion p.52) but they read as document sections rather than full-page MECE dividers; the I/1/i/A nesting is logical yet hard to navigate as a deck.", "closingCritique": "p.52 'III. CONCLUSION' restates the finding and p.53 ends on the Committee 'remains committed to uncovering the full scope' — a continuation, not a call to action with concrete asks (rule changes, referrals, deadlines). Memorable theme but the deck stops, rather than closes.", "openingCritique": "The opening lands the thesis fast: an executive summary on p.3 followed by two assertion-titled slides on p.4-5 ('McKinsey utilized its federal government contracts... to solicit private sector business' and 'McKinsey failed to disclose its serious, longstanding conflicts of interests'). The cover and TOC are conventional but the three-slide 'lead with the answer' opening is textbook Storymakers.", "extractionSeconds": 88.43178, "narrativeCritique": "The document traces a coherent S→C→A→R arc: exec summary frames the problem (p.3-5), case studies build the evidence (p.7-34), the legal violation argument lands (p.37-39), and a conclusion closes (p.52-53). The arc is solid but lopsided — the 'analysis' middle dominates roughly 40 slides while resolution gets two, and there is no explicit recommendation act.", "titleQualityScore": 64, "titleQualityCritique": "Strong declarative titles dominate the argument slides — e.g. p.17 'McKinsey's FDA Contracts Overlapped with McKinsey's Work for Opioid Manufacturers, Creating Significant Conflicts of Interest' and p.31 'McKinsey Used FDA Experience to Win Business from Purdue's CEO' — but the case-study spine collapses into bare proper nouns ('Navjot Singh' p.9, 'Jeff Smith' p.10, 'Sastry Chilukuri' p.11, 'Katy George' p.14) and several pages have only a page number as title (p.18, p.28, p.42, p.43, p.51)." }, "activistThesis": null, "pitchdeck": { "metadata": null, "profile": null }, "slides": [ { "page": 1, "type": "setup", "function": "front_matter", "imagePath": "https://imgproxy.kitesheet.com/PG9VCsw6qEaJOtFa1AYJLUywxVnybwIlMHNa4jvh-jo/rs:fit:1200:1200:0/q:82/f:webp/czM6Ly9raXRlc2hlZXQvY29ycHVzL3NsaWRlcy8xNThkZjg2MjdhMGI5YWNhL3AwMDEuanBn", "rawType": "cover", "block": null, "metadata": { "slideType": "cover", "slideTypeCanon": { "name": "Cover", "slug": "cover", "status": "active", "canonId": "019de52d-05f2-729d-9f93-e0504f0a2410", "version": 1, "description": null }, "function": "front_matter", "functionCanon": { "name": "Front matter", "slug": "front_matter", "status": "active", "canonId": "019de52d-133d-73f0-9e26-201eda96b098", "version": 1, "description": null }, "density": "sparse", "densityScore": 15, "componentCount": 3, "textChars": 262, "nDataPoints": 0, "notes": null, "elementsJson": [ "logo_grid", "paragraph" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:33.538+00", "seconds": 2.072, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/1", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-1", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": { "h": 0.35, "w": 0.5, "x": 0.25, "y": 0.05 }, "kind": "image", "text": "U.S. House of Representatives Seal", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Logo", "slug": "logo", "status": "active", "canonId": "019de52c-fdaf-743d-94c4-d7c6a0e55302", "version": 1, "description": null }, "framework": null }, "subkind": "logo", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:33.538+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "997b08f7-e786-4f12-94fd-b77f2bef004d", "parentComponentId": null }, { "bbox": { "h": 0.2, "w": 0.6, "x": 0.2, "y": 0.65 }, "kind": "paragraph", "text": "Interim Majority Staff Report\nCommittee on Oversight and Reform\nU.S. House of Representatives\nApril 13, 2022\noversight.house.gov", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:33.538+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "49efcf27-b79e-44ad-8c16-635b335014fd", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.8, "x": 0.1, "y": 0.45 }, "kind": "title", "text": "The Firm and the FDA: McKinsey & Company’s Conflicts of Interest at the Heart of the Opioid Epidemic", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:33.538+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "28c9f57e-e0d3-4170-984a-9e0f8bbf1536", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 5, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 1, "name": "Problem & Complication", "beatId": "879d5693-fa0d-471e-8bc6-dddb3a68ee78", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Problem & Complication", "slug": "consultants-gambit-problem-complication", "status": "active", "canonId": "019dd9b8-064a-777f-a374-e9a8c43dedd4", "version": 1, "description": null }, "evidence": "The document introduces the problem of McKinsey's conflicts of interest and complicates it through examples of overlapping work.", "position": 0, "isPrimaryArc": true, "parentBeatType": { "name": "Complication", "slug": "complication", "status": "active", "canonId": "019dd9b8-0275-7709-b2d6-4f77c3fc7579", "version": 1, "description": "The point in the narrative where the audience should feel discomfort. Required for argumentative arcs." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "thumbSrc": "https://imgproxy.kitesheet.com/31rGtbRe2mcHjKJq8A1rcxO0QcnY-oEa2656KhjMb-U/rs:fit:480:480:0/q:78/f:webp/czM6Ly9raXRlc2hlZXQvY29ycHVzL3NsaWRlcy8xNThkZjg2MjdhMGI5YWNhL3AwMDEuanBn", "imagePathAlt": "https://imgproxy.kitesheet.com/e4VGv9AdjFS8zIvxppkrGreCa9rQLmrFuOwyv-rbndU/rs:fit:1200:1200:0/q:82/f:webp/czM6Ly9raXRlc2hlZXQvY29ycHVzL3NsaWRlcy8xNThkZjg2MjdhMGI5YWNhL3AwMDEucG5n", "thumbSrcAlt": "https://imgproxy.kitesheet.com/ZV_RhF_nH1lz8gh2AMxmYWg5jcbjc-8IQ-7zt1Z4iuw/rs:fit:480:480:0/q:78/f:webp/czM6Ly9raXRlc2hlZXQvY29ycHVzL3NsaWRlcy8xNThkZjg2MjdhMGI5YWNhL3AwMDEucG5n" }, { "page": 2, "type": "setup", "function": "front_matter", "rawType": "table_of_contents", "block": null, "metadata": { "slideType": "table_of_contents", "slideTypeCanon": { "name": "Table of contents", "slug": "table_of_contents", "status": "active", "canonId": "019de52d-0643-721b-9b85-69676bb85cf8", "version": 1, "description": null }, "function": "front_matter", "functionCanon": { "name": "Front matter", "slug": "front_matter", "status": "active", "canonId": "019de52d-133d-73f0-9e26-201eda96b098", "version": 1, "description": null }, "density": "sparse", "densityScore": 23, "componentCount": 2, "textChars": 510, "nDataPoints": 0, "notes": null, "elementsJson": [ "numbered_list" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:34.423+00", "seconds": 2.953, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/2", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-2", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": { "h": 0.75, "w": 0.764, "x": 0.118, "y": 0.133 }, "kind": "list", "text": "EXECUTIVE SUMMARY ... 3\nI. INTRODUCTION ... 6\nII. FINDINGS ... 7\nA. McKinsey Consultants Engaged in Overlapping Work for Opioid Manufacturers and FDA ... 7\nB. McKinsey Utilized Government Contracts to Secure Private Sector Business ... 30\nC. McKinsey Failed to Disclose Serious Conflicts of Interest ... 34\nD. McKinsey Consultants Working for Opioid Manufacturers Influenced Policy Documents McKinsey Submitted to Government Clients ... 40\nE. Document Destruction ... 50\nIII. CONCLUSION ... 52", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:34.423+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "49c2300d-a413-42bd-98b2-fe12cbe557f3", "parentComponentId": null }, { "bbox": { "h": 0.015, "w": 0.175, "x": 0.118, "y": 0.116 }, "kind": "title", "text": "TABLE OF CONTENTS", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:34.423+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e745e543-e8ae-4b5f-990b-6cf4e8b8bdba", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 5, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 1, "name": "Problem & Complication", "beatId": "879d5693-fa0d-471e-8bc6-dddb3a68ee78", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Problem & Complication", "slug": "consultants-gambit-problem-complication", "status": "active", "canonId": "019dd9b8-064a-777f-a374-e9a8c43dedd4", "version": 1, "description": null }, "evidence": "The document introduces the problem of McKinsey's conflicts of interest and complicates it through examples of overlapping work.", "position": 0, "isPrimaryArc": true, "parentBeatType": { "name": "Complication", "slug": "complication", "status": "active", "canonId": "019dd9b8-0275-7709-b2d6-4f77c3fc7579", "version": 1, "description": "The point in the narrative where the audience should feel discomfort. Required for argumentative arcs." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 3, "type": "setup", "title": "This is a text-heavy document page, likely from a congressional or oversight committee report.", "function": "summarize", "rawType": "executive_summary", "block": null, "metadata": { "slideType": "executive_summary", "slideTypeCanon": { "name": "Executive summary", "slug": "executive_summary", "status": "active", "canonId": "019de52d-06be-73ff-81b3-f99fe7f0025e", "version": 1, "description": null }, "function": "summarize", "functionCanon": { "name": "Summarize", "slug": "summarize", "status": "active", "canonId": "019de52d-1541-704f-b86f-bf7b75056373", "version": 1, "description": null }, "density": "dense", "densityScore": 62, "componentCount": 6, "textChars": 1021, "nDataPoints": 3, "notes": "This is a text-heavy document page, likely from a congressional or oversight committee report.", "elementsJson": [ "headline_text", "paragraph", "bullet_list" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:34.498+00", "seconds": 2.809, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/3", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-3", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "At least 22 McKinsey consultants, including senior partners, worked for both FDA and opioid manufacturers on related topics, including at the same time.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:48+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49a-b3f9ee799045", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.764, "x": 0.118, "y": 0.5 }, "kind": "list", "text": "At least 22 McKinsey consultants, including senior partners, worked for both FDA and opioid manufacturers on related topics, including at the same time.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:34.498+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "329abad7-2990-48c9-b122-88aea5ac8ecc", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.7, "x": 0.18, "y": 0.63 }, "kind": "list", "text": "In 2009, McKinsey staffed a consultant on a project in which the firm recommended Purdue \"defend against strict treatment by the FDA\"... In 2011, at least four McKinsey consultants working on a $1.8 million FDA contract... were simultaneously working for Purdue.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:34.498+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e6c69ff7-d38a-4235-a97f-1cc78aed43c5", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.764, "x": 0.118, "y": 0.28 }, "kind": "paragraph", "text": "The Committee's investigation has uncovered significant, years-long conflicts of interest at McKinsey, resulting from its work for the federal government at the same time that it was advising opioid manufacturers.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:34.498+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5e63ae76-b3e7-4fc1-8a14-fd03dcc1e8f3", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.764, "x": 0.118, "y": 0.15 }, "kind": "paragraph", "text": "This interim staff report presents preliminary findings from the Committee's investigation into McKinsey & Company's (McKinsey) consulting services for opioid and pharmaceutical companies and McKinsey's conflicts of interest.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:34.498+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cfebbf85-85a7-4770-b872-4c51989c0817", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.118, "y": 0.118 }, "kind": "title", "text": "EXECUTIVE SUMMARY", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:34.498+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1b091483-6e48-4136-8eec-12b86f7ab7c4", "parentComponentId": null } ], "metrics": [], "tools": [ { "tool": { "name": "Executive summary", "slug": "executive-summary", "status": "active", "bestFor": null, "canonId": "019dd9e1-4b63-72d5-9734-da757d91ca61", "version": 1, "bodyDocId": null, "description": "A condensed view of the entire argument on a single slide / block.", "familyLabel": null, "categoryName": null, "categorySlug": null }, "agent": null, "layer": "slide", "agents": null, "matchId": "5846591a-8abf-40ca-8bc3-bcb6240ea0a9", "evidence": "This interim staff report presents preliminary findings from the Committee's investigation into McKinsey & Company's (McKinsey) consulting services for opioid and pharmaceutical companies and McKinse", "pageRefs": null, "priority": null, "whenToUse": null, "confidence": 0.9, "extraction": { "at": "2026-07-17 03:16:17.019916+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 3, "whyItWorks": null, "antipattern": null, "cardinality": "common", "narrativePurpose": null } ], "frameworks": [], "arcBeats": [ { "to": 5, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 1, "name": "Problem & Complication", "beatId": "879d5693-fa0d-471e-8bc6-dddb3a68ee78", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Problem & Complication", "slug": "consultants-gambit-problem-complication", "status": "active", "canonId": "019dd9b8-064a-777f-a374-e9a8c43dedd4", "version": 1, "description": null }, "evidence": "The document introduces the problem of McKinsey's conflicts of interest and complicates it through examples of overlapping work.", "position": 0, "isPrimaryArc": true, "parentBeatType": { "name": "Complication", "slug": "complication", "status": "active", "canonId": "019dd9b8-0275-7709-b2d6-4f77c3fc7579", "version": 1, "description": "The point in the narrative where the audience should feel discomfort. Required for argumentative arcs." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 4, "type": "setup", "title": "This slide appears to be part of a larger report or legal disclosure document, indicated by the page number '4' at the bottom.", "function": "summarize", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "summarize", "functionCanon": { "name": "Summarize", "slug": "summarize", "status": "active", "canonId": "019de52d-1541-704f-b86f-bf7b75056373", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 91, "componentCount": 11, "textChars": 2090, "nDataPoints": 1, "notes": "This slide appears to be part of a larger report or legal disclosure document, indicated by the page number '4' at the bottom.", "elementsJson": [ "bullet_list" ], "confidence": 0.9, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:43.995+00", "seconds": 12.002, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/4", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-4", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "McKinsey utilized its federal government contracts, connections, and influence to solicit private sector business.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:47+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b499-f5f9da3e7d04", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.65, "x": 0.23, "y": 0.62 }, "kind": "list", "text": "In 2016, a McKinsey partner encouraged other consultants to share information with Purdue about ongoing drug safety work McKinsey was doing for FDA, saying they should 'talk about our work w FDA.'", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.995+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "30ca8201-22c4-4093-880c-e24a78112f82", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.71, "x": 0.17, "y": 0.29 }, "kind": "list", "text": "McKinsey utilized its federal government contracts, connections, and influence to solicit private sector business: Documents show McKinsey consultants sought to leverage their government contacts and experience to solicit private sector business.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.995+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "3b69eea2-111c-418b-8f60-8b1aca75c16f", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.71, "x": 0.17, "y": 0.71 }, "kind": "list", "text": "McKinsey submitted opioid advice to the Trump Administration, including information that went to the HHS Secretary and FDA Commissioner: Documents show that McKinsey consultants with Purdue ties attempted to influence public health officials.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.995+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5c77ffb9-abd3-4722-bff4-66b4a73b1f01", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.65, "x": 0.23, "y": 0.375 }, "kind": "list", "text": "In 2009, in a bid to lead a working group of opioid manufacturers, McKinsey highlighted that due to its direct work for regulators, the company had 'developed insights into the perspectives of the regulators themselves.'", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.995+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7250ecb3-ac5f-47b0-a928-12808a118621", "parentComponentId": null }, { "bbox": { "h": 0.07, "w": 0.65, "x": 0.23, "y": 0.46 }, "kind": "list", "text": "In 2014, a McKinsey partner wrote to Purdue's CEO that McKinsey brought an 'unequaled capability based on who we know and what we know,' highlighting the firm's work for 'State and Federal Regulators.'", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.995+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "752dc680-0b05-4583-b08f-3e465b34d026", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.65, "x": 0.23, "y": 0.115 }, "kind": "list", "text": "One senior McKinsey consultant worked on three FDA projects from 2014 to 2018 to assess the safety of dangerous drugs through the FDA Sentinel Initiative while simultaneously advising Purdue.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.995+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "da409946-deda-4f08-b05a-0e29328edb1c", "parentComponentId": null }, { "bbox": { "h": 0.07, "w": 0.65, "x": 0.23, "y": 0.185 }, "kind": "list", "text": "In 2017, a McKinsey partner began work on a $2.7 million contract to help modernize FDA's Office of New Drugs—at the same time the McKinsey consultant was advising Purdue on maximizing the market potential of a new opioid.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.995+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "dbd44677-e829-4c85-9e5a-fdea49a5409d", "parentComponentId": null }, { "bbox": { "h": 0.07, "w": 0.65, "x": 0.23, "y": 0.815 }, "kind": "list", "text": "In 2018, McKinsey consultants drafted a 'transition memo' to incoming HHS Secretary Alex Azar. The memo contained input from McKinsey consultants who did work for Purdue, including one who recommended strategies to 'Turbocharge Purdue's Sales Engine.'", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.995+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f23c7c26-084a-4288-95f2-d1270cb84400", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.02, "x": 0.49, "y": 0.935 }, "kind": "paragraph", "text": "4", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.995+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "720418b5-7151-4249-b0ad-a2d009410792", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "McKinsey brought an “unequaled capability based on who we know and what we know,” highlighting the firm’s work for “State and Federal Regulators,” including “FDA, who we have supported for over five years.”", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:47+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b499-fb0182696fda", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 5, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 1, "name": "Problem & Complication", "beatId": "879d5693-fa0d-471e-8bc6-dddb3a68ee78", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Problem & Complication", "slug": "consultants-gambit-problem-complication", "status": "active", "canonId": "019dd9b8-064a-777f-a374-e9a8c43dedd4", "version": 1, "description": null }, "evidence": "The document introduces the problem of McKinsey's conflicts of interest and complicates it through examples of overlapping work.", "position": 0, "isPrimaryArc": true, "parentBeatType": { "name": "Complication", "slug": "complication", "status": "active", "canonId": "019dd9b8-0275-7709-b2d6-4f77c3fc7579", "version": 1, "description": "The point in the narrative where the audience should feel discomfort. Required for argumentative arcs." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 5, "type": "setup", "title": "This appears to be a page from a congressional or investigative report.", "function": "summarize", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "summarize", "functionCanon": { "name": "Summarize", "slug": "summarize", "status": "active", "canonId": "019de52d-1541-704f-b86f-bf7b75056373", "version": 1, "description": null }, "density": "dense", "densityScore": 71, "componentCount": 7, "textChars": 3018, "nDataPoints": 0, "notes": "This appears to be a page from a congressional or investigative report.", "elementsJson": [ "bullet_list", "paragraph" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:35.855+00", "seconds": 3.526, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/5", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-5", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "McKinsey failed to disclose its serious, longstanding conflicts of interests to FDA, potentially violating contract requirements and federal law.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:47+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49a-7c701da137e7", "parentComponentId": null }, { "bbox": { "h": 0.22, "w": 0.63, "x": 0.238, "y": 0.326 }, "kind": "list", "text": "McKinsey failed to disclose its serious, longstanding conflicts of interests to FDA, potentially violating contract requirements and federal law: The Federal Acquisition Regulation (FAR) sets rules for federal agencies, including the FDA, to avoid, neutralize, and mitigate organizational conflicts of interest before awarding contracts. Pursuant to those regulations, many of McKinsey’s FDA contracts affirmatively required contractors submitting proposals to disclose potential organizational conflicts of interest. However, McKinsey produced no evidence to the Committee that it ever disclosed its extensive, ongoing work for opioid manufacturers to FDA. McKinsey appears to have repeatedly certified that there were “no relevant facts or circumstances which would give rise to an organizational conflict of interest.” False certifications on federal contracts can lead to civil or criminal penalties, including under the False Claims Act.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:35.855+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1e891edb-4162-44d8-a516-4e39ef719ee2", "parentComponentId": null }, { "bbox": { "h": 0.22, "w": 0.63, "x": 0.238, "y": 0.568 }, "kind": "list", "text": "McKinsey consultants discussed deleting documents related to their work for Purdue: Documents obtained by the Committee reveal that as early as May 2017, McKinsey partners discussed ways to keep McKinsey’s documents from being discovered in Purdue’s ongoing lawsuits, including putting presentations on a “neutral template” without Purdue’s logo and only showing “hard” or paper copies of presentations to Purdue. One McKinsey senior partner described the perceived benefit of the latter approach: “It will live only on our laptops and then we can delete.” Public reporting has shown that in July 2018, senior partners at McKinsey discussed destroying their documents related to their work for Purdue. Documents obtained by the Committee show one of these senior partners later emailed himself a note to “delete old pur documents from laptop.”", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:35.855+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2a1857a3-2a4c-44f1-8263-346de30e9ffd", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.63, "x": 0.238, "y": 0.203 }, "kind": "list", "text": "McKinsey consultants discussed the firm’s influence on a speech by FDA Commissioner Gottlieb in 2018 concerning a drug safety monitoring program. They noted that a claim about opioids made by another McKinsey consultant who had worked for both FDA and an opioid manufacturer “got into one of Scott Gottlieb’s public speeches” even though the consultant had “made it up entirely.”", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:35.855+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "410be54e-d5f7-45d6-bc8b-213e77d14707", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.63, "x": 0.238, "y": 0.116 }, "kind": "paragraph", "text": "recommended that the memo to Secretary Azar emphasize the “important societal benefit” of opioids. The final memo included certain recommendations that appear aligned with the interests of McKinsey’s private sector opioid clients.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:35.855+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "822b55b7-c84c-42fc-824e-94f3613da8a4", "parentComponentId": null }, { "bbox": { "h": 0.07, "w": 0.75, "x": 0.118, "y": 0.778 }, "kind": "paragraph", "text": "Despite evidence of conflicts of interest resulting from McKinsey’s work for the federal government and private sector clients, and the possibility that such conflicts may have contributed to America’s deadly opioid epidemic, McKinsey has refused to fully cooperate with the Committee’s investigation. In particular, McKinsey has failed to provide basic information about certain clients and the work McKinsey did for them.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:35.855+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ff096077-7d77-45f0-b0e1-0a187ae01b0d", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "It will live only on our laptops and then we can delete.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:47+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49a-803d6b630c52", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 5, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 1, "name": "Problem & Complication", "beatId": "879d5693-fa0d-471e-8bc6-dddb3a68ee78", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Problem & Complication", "slug": "consultants-gambit-problem-complication", "status": "active", "canonId": "019dd9b8-064a-777f-a374-e9a8c43dedd4", "version": 1, "description": null }, "evidence": "The document introduces the problem of McKinsey's conflicts of interest and complicates it through examples of overlapping work.", "position": 0, "isPrimaryArc": true, "parentBeatType": { "name": "Complication", "slug": "complication", "status": "active", "canonId": "019dd9b8-0275-7709-b2d6-4f77c3fc7579", "version": 1, "description": "The point in the narrative where the audience should feel discomfort. Required for argumentative arcs." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 6, "type": "setup", "title": "This appears to be a page from a formal report or congressional document.", "function": "establish_context", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "establish_context", "functionCanon": { "name": "Establish context", "slug": "establish_context", "status": "active", "canonId": "019de52d-1314-74e6-9074-d213dc0bdcdf", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 75, "componentCount": 7, "textChars": 1740, "nDataPoints": 6, "notes": "This appears to be a page from a formal report or congressional document.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:40.09+00", "seconds": 7.716, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/6", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-6", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": { "h": 0.048, "w": 0.764, "x": 0.118, "y": 0.158 }, "kind": "paragraph", "text": "McKinsey is one of the world's oldest and most prestigious consulting firms, with reported revenues over $10 billion per year. Famed for its secrecy, McKinsey does not disclose the names of its clients nor the advice it gives them.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.09+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1eefed80-671e-4ee0-a545-dcdd545b4e19", "parentComponentId": null }, { "bbox": { "h": 0.081, "w": 0.764, "x": 0.118, "y": 0.558 }, "kind": "paragraph", "text": "Following this landmark settlement and reports of other potential conflicts of interest at the firm, on November 5, 2021, the Committee on Oversight and Reform sent a letter to McKinsey requesting documents and information regarding the company's consulting services for the opioid and pharmaceutical industries...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.09+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "722d880b-2d50-4bb7-888e-055c6ca288c4", "parentComponentId": null }, { "bbox": { "h": 0.115, "w": 0.764, "x": 0.118, "y": 0.358 }, "kind": "paragraph", "text": "Since at least 2004, McKinsey also consulted for opioid manufacturers including Purdue, Johnson & Johnson, Mallinckrodt Pharmaceuticals, and Endo International. From 2004 to 2019, McKinsey played a pivotal role in increasing Purdue's sales of OxyContin...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.09+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8339aae4-f5b8-4b34-9cce-94c127340226", "parentComponentId": null }, { "bbox": { "h": 0.048, "w": 0.764, "x": 0.118, "y": 0.491 }, "kind": "paragraph", "text": "In February 2021, McKinsey reached a $573 million agreement with 53 attorneys general to resolve allegations that it engaged in unfair trade practices by aggressively promoting the sale of higher doses of opioids for longer periods of time.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.09+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a7e0b2d2-4dc2-44fa-b084-1151b0c3b336", "parentComponentId": null }, { "bbox": { "h": 0.115, "w": 0.764, "x": 0.118, "y": 0.225 }, "kind": "paragraph", "text": "Over the past 15 years, McKinsey has reaped hundreds of millions of dollars in fees from consulting for the federal government and opioid manufacturers, sometimes simultaneously. From January 2006 to March 2019, the federal government paid McKinsey $956.2 million in taxpayer funds. Since 2008, FDA alone has paid McKinsey more than $140 million, including $40 million from FDA's Center for Drug Evaluation and Research (CDER)...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.09+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ac9b19e9-db82-4697-84e3-3422083a448e", "parentComponentId": null }, { "bbox": { "h": 0.065, "w": 0.764, "x": 0.118, "y": 0.815 }, "kind": "source-note", "text": "1 Duff McDonald, The Firm: The Story of McKinsey and Its Secret Influence on American Business (2013). 2 General Services Administration, Improper Pricing on the McKinsey Professional Services Contract May Cost the United States an Estimated $69 Million...", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.09+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "fbc7f2ef-47cc-4f92-801a-06b53c333775", "parentComponentId": null }, { "bbox": { "h": 0.016, "w": 0.215, "x": 0.118, "y": 0.123 }, "kind": "title", "text": "I. INTRODUCTION", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.09+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a47a7367-39cd-4b85-9d9f-e735e18d48e0", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 7, "type": "setup", "title": "This is a page from a formal report or legal document, likely a Congressional Committee report.", "function": "summarize", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "summarize", "functionCanon": { "name": "Summarize", "slug": "summarize", "status": "active", "canonId": "019de52d-1541-704f-b86f-bf7b75056373", "version": 1, "description": null }, "density": "dense", "densityScore": 62, "componentCount": 6, "textChars": 1113, "nDataPoints": 1, "notes": "This is a page from a formal report or legal document, likely a Congressional Committee report.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:35.933+00", "seconds": 3.07, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/7", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-7", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "The Committee’s investigation has uncovered evidence that McKinsey consultants advised FDA on opioid-related regulatory matters at the same time they were advising Purdue and other opioid manufacturers on sales and regulatory strategies involving FDA.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:47+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49a-479d168c5f52", "parentComponentId": null }, { "bbox": { "h": 0.075, "w": 0.764, "x": 0.118, "y": 0.551 }, "kind": "paragraph", "text": "Although McKinsey has failed to produce certain responsive documents related to its conflicts of interest, the documents the Committee has obtained illustrate pervasive conflicts of interest at the company. These documents reveal that at least 22 McKinsey consultants worked for both FDA and opioid manufacturers, including several of McKinsey’s senior-most partners in", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:35.933+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9f408802-f92e-4da6-8bd3-f27506c7fab7", "parentComponentId": null }, { "bbox": { "h": 0.055, "w": 0.764, "x": 0.118, "y": 0.481 }, "kind": "paragraph", "text": "The Committee’s investigation has uncovered evidence that McKinsey consultants advised FDA on opioid-related regulatory matters at the same time they were advising Purdue and other opioid manufacturers on sales and regulatory strategies involving FDA.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:35.933+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ac9a1bdb-1edb-4fc8-b8da-1713c2a72bbb", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.764, "x": 0.118, "y": 0.635 }, "kind": "source-note", "text": "3 Letter from Chairwoman Carolyn B. Maloney... 4 The Committee has released selected documents... 5 Id. In its November 5, 2021, request letter...", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:35.933+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "54f28300-78f1-4ae2-8c03-be4418d23344", "parentComponentId": null }, { "bbox": { "h": 0.035, "w": 0.764, "x": 0.118, "y": 0.428 }, "kind": "title", "text": "A. McKinsey Consultants Engaged in Overlapping Work for Opioid Manufacturers and FDA", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Action title", "slug": "action-title", "status": "active", "canonId": "019de52c-fb31-734c-a0f5-a3935b73135d", "version": 1, "description": null }, "framework": null }, "subkind": "action-title", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:35.933+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e7de4af7-18f9-43c6-be2f-32af2e6742bf", "parentComponentId": null }, { "bbox": { "h": 0.015, "w": 0.135, "x": 0.118, "y": 0.396 }, "kind": "title", "text": "II. FINDINGS", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:35.933+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1a63bfa8-1cfd-49ed-8bd6-b392474443b1", "parentComponentId": null } ], "metrics": [], "tools": [ { "tool": { "name": "Audience Definition", "slug": "audience-definition", "status": "active", "bestFor": null, "canonId": "019dd956-7f2a-775d-aeee-ff099bcb7756", "version": 1, "bodyDocId": null, "description": "Six key questions: Who are they? What do they know? What do they believe? What do they care about? What do they fear? What decisions can they make?", "familyLabel": null, "categoryName": "Block", "categorySlug": "block" }, "agent": "Storyteller", "layer": "slide", "agents": [ "Storyteller" ], "matchId": "6847df5a-d81e-49f9-b2b2-7891fc12c2bb", "evidence": "The Committee’s investigation has uncovered evidence that McKinsey consultants advised FDA on opioid-related regulatory matters at the same time they were advising Purdue and other opioid manufacturers on sales", "pageRefs": null, "priority": "Core", "whenToUse": null, "confidence": 0.7, "extraction": { "at": "2026-07-17 03:16:17.186547+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 7, "whyItWorks": null, "antipattern": null, "cardinality": null, "narrativePurpose": null } ], "frameworks": [], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 8, "type": "setup", "title": "This appears to be a page from a formal government or investigative report.", "function": "summarize", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "summarize", "functionCanon": { "name": "Summarize", "slug": "summarize", "status": "active", "canonId": "019de52d-1541-704f-b86f-bf7b75056373", "version": 1, "description": null }, "density": "dense", "densityScore": 67, "componentCount": 6, "textChars": 2082, "nDataPoints": 4, "notes": "This appears to be a page from a formal government or investigative report.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 0.9, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:36.678+00", "seconds": 3.75, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/8", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-8", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "McKinsey failed to disclose its commercial relationships with these opioid manufacturers to FDA.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:50+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49c-9c73f606d5da", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "Number of contracts: 76", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:50+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49c-a0422404cfb2", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.78, "x": 0.11, "y": 0.41 }, "kind": "paragraph", "text": "From 2008 to 2022, McKinsey performed on 76 contracts for the FDA. FDA has paid McKinsey more than $140 million since 2008, including $40 million from CDER, which oversees opioid-related programs. McKinsey provided the Committee with an engagement list for the company's work on 37 FDA matters—fewer than half of the contracts reported in government databases—along with the consultants who worked on those matters. During this period, McKinsey consultants also worked extensively for Purdue. According to an engagement list obtained by the Committee, from 2004 to 2019, McKinsey consulted on at least 75 separate engagements for Purdue and its affiliates. These engagements ranged in duration from several weeks to over a year, and covered subjects ranging from sales", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:36.678+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "24ae42cd-98ff-425b-be5e-6e4920c498d5", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.78, "x": 0.11, "y": 0.11 }, "kind": "paragraph", "text": "the health care and regulatory practices who worked for FDA and opioid manufacturers at the same time. According to information provided by FDA in response to a request from the Senate and public records requests, McKinsey failed to disclose its commercial relationships with these opioid manufacturers to FDA. The Committee has also obtained evidence that McKinsey shared information that it received through its consulting work for FDA with other McKinsey consultants, and potentially with private sector clients. Documents show that at least one McKinsey consultant encouraged colleagues to share information obtained from their FDA projects with Purdue. Other McKinsey consultants working for both FDA and Purdue appear to have shared FDA proposals within McKinsey, even when senior FDA officials requested that McKinsey limit the distribution of those proposals to certain consultants.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:36.678+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a567c65d-5af7-43f1-8194-175f9bf0c86d", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.78, "x": 0.11, "y": 0.67 }, "kind": "source-note", "text": "6 McKinsey produced to the Committee staffing information for 37 FDA-McKinsey contracts between 2010 and 2022... 7 Letter from Acting Associate Commissioner Andrew Tantillo... 8 USA Spending... 9 See MCK-HCOR-0355686 to MCK-HCOR-0355698...", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:36.678+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "38a85d6f-feb7-43f7-a8f0-37223243a4d5", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.78, "x": 0.11, "y": 0.37 }, "kind": "title", "text": "1. McKinsey Consultants Worked Extensively for Both FDA and Purdue", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:36.678+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0e209e7d-541f-4b00-ac5b-cd3ebe5ff00b", "parentComponentId": null } ], "metrics": [ { "metricRaw": "Number of contracts", "numberRaw": "76", "numberKind": "plain", "actionTitle": "McKinsey Consultants Worked Extensively for Both FDA and Purdue", "calloutText": "McKinsey failed to disclose its commercial relationships with these opioid manufacturers to FDA.", "numberScale": null, "numberValue": 76, "metricFamily": "volume_count", "numberCurrency": null } ], "tools": [ { "tool": { "name": "List presentation", "slug": "list-presentation", "status": "active", "bestFor": null, "canonId": "019dd9e1-4ef7-777d-ba68-9074c2b3bcf1", "version": 1, "bodyDocId": null, "description": "Bulleted, numbered, or checklist enumerations.", "familyLabel": null, "categoryName": null, "categorySlug": null }, "agent": null, "layer": "slide", "agents": null, "matchId": "5abf7d55-d5e6-487b-bacf-e9bead3b0544", "evidence": "From 2008 to 2022, McKinsey performed on 76 contracts for the FDA. FDA has paid McKinsey more than $140 million since 2008, including $40 million from CDER, which oversees opioid-related programs.", "pageRefs": null, "priority": null, "whenToUse": null, "confidence": 0.8, "extraction": { "at": "2026-07-17 03:16:17.255698+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 8, "whyItWorks": null, "antipattern": null, "cardinality": "common", "narrativePurpose": null } ], "frameworks": [], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 9, "type": "evidence", "title": "This appears to be a page from a formal investigative report or congressional document.", "function": "cite_precedent", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "cite_precedent", "functionCanon": { "name": "Cite precedent", "slug": "cite_precedent", "status": "active", "canonId": "019de52d-142b-714b-86d4-58aad7b568ec", "version": 1, "description": null }, "density": "dense", "densityScore": 62, "componentCount": 6, "textChars": 2192, "nDataPoints": 0, "notes": "This appears to be a page from a formal investigative report or congressional document.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:36.687+00", "seconds": 3.599, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/9", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-9", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": { "h": 0.085, "w": 0.764, "x": 0.118, "y": 0.205 }, "kind": "paragraph", "text": "During this period, numerous McKinsey consultants worked for both FDA and Purdue, both officially and unofficially. Three senior McKinsey consultants—Navjot Singh, Jeff Smith, and Sastry Chilukuri—highlight this crossover and the unclear boundaries between consultants not directly staffed on projects. Another McKinsey senior partner, Arnab Ghatak, played a key role at Purdue and appears to have contributed to work prepared for incoming HHS Secretary Alex Azar, although he did not work directly for FDA.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:36.687+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "01a23093-b67d-464a-95bc-c5bc7f2c5cff", "parentComponentId": null }, { "bbox": { "h": 0.115, "w": 0.764, "x": 0.118, "y": 0.362 }, "kind": "paragraph", "text": "McKinsey Senior Partner Navjot Singh is one of McKinsey's lead consultants to FDA. Internal McKinsey emails obtained by the Committee show that he also participated unofficially in Purdue matters. In a 2021 FDA subcontract, McKinsey describes Mr. Singh as possessing '10 years of experience driving cross-Center collaboration for FDA, having led 80+ engagements at the Agency.'12 Of the 37 FDA contracts for which McKinsey provided staffing information to the Committee, Mr. Singh is staffed on 35 of them.13 In addition to his work at FDA, Mr. Singh leads McKinsey's state and local work for McKinsey's public sector practice in North America.14", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:36.687+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "3a551a3e-a6e7-478f-94f8-645f7658911d", "parentComponentId": null }, { "bbox": { "h": 0.075, "w": 0.764, "x": 0.118, "y": 0.118 }, "kind": "paragraph", "text": "strategy to regulatory advice. Documents indicate that in April 2008, McKinsey ratcheted up its consulting work for Purdue after the manufacturer and several senior executives pled guilty to federal charges of misbranding OxyContin.10 In 2009, one McKinsey consultant sent an email to colleagues referring to McKinsey's 'mini 'army' here at Purdue.'11", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:36.687+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6ccf5173-2180-4ae6-8812-84483336e2ee", "parentComponentId": null }, { "bbox": { "h": 0.105, "w": 0.764, "x": 0.118, "y": 0.49 }, "kind": "paragraph", "text": "Documents show Mr. Singh played a key role in McKinsey's efforts to renew its relationship with Purdue in November 2007, advising the lead McKinsey consultants pitching Purdue, attending meetings with Purdue executives—including Purdue's then-CEO—on the company's research and development organization, and producing slides for pitch presentations.15 In one email exchange in December 2007, Mr. Singh told a McKinsey colleague that he would try to join a call for Purdue, but would be 'in transit to a meeting at the FDA.'16 In another email with the subject: 'Help on Purdue page,' Mr. Singh stated: 'I am now going to", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:36.687+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "99edfe4c-d2ad-4acc-8f00-0b10b1daec7f", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.764, "x": 0.118, "y": 0.69 }, "kind": "source-note", "text": "10-16 citations detailing specific documents and sources.", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:36.687+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5427be6d-8f73-4a52-ac32-95bb8d6c7052", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.125, "x": 0.175, "y": 0.325 }, "kind": "title", "text": "Navjot Singh", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:36.687+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ad5712a8-316b-4674-83a1-f574f1ff84a6", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 10, "type": "setup", "title": "This appears to be a page from a formal report or legal document, likely an appendix or disclosure section.", "function": "other", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "other", "functionCanon": { "name": "Other (fallback)", "slug": "other", "status": "active", "canonId": "019de52d-15e1-75bc-99dc-07732380e2ce", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 81, "componentCount": 9, "textChars": 1773, "nDataPoints": 0, "notes": "This appears to be a page from a formal report or legal document, likely an appendix or disclosure section.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 0.9, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:43.444+00", "seconds": 10.315, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/10", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-10", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "Of the 37 FDA contracts for which McKinsey provided staffing information to the Committee, Mr. Smith was staffed on 28 of them.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:46+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b499-899bdb579a78", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.764, "x": 0.118, "y": 0.65 }, "kind": "paragraph", "text": "At the same time that Mr. Smith was working for FDA, internal McKinsey documents show he was also a leader of McKinsey’s consulting work for Purdue. From 2009 to 2017, Mr.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.444+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "11c66f9f-0051-46e8-8f06-e9edf3433b92", "parentComponentId": null }, { "bbox": { "h": 0.055, "w": 0.764, "x": 0.118, "y": 0.163 }, "kind": "paragraph", "text": "Although Mr. Singh was not formally identified as a consultant to Purdue, he appears to have been held out in communications with Purdue as a potential source of expertise.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.444+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6b6c43a8-192c-4272-a5c1-4a24afc8fed3", "parentComponentId": null }, { "bbox": { "h": 0.085, "w": 0.764, "x": 0.118, "y": 0.255 }, "kind": "paragraph", "text": "Internally, Mr. Singh appears to have served as an informal advisor to McKinsey teams working on Purdue matters. In 2009 and 2010, Purdue engaged McKinsey to assist in preparing a regulatory submission to FDA concerning the safety and utility of Purdue’s “BuTrans” opioid dispensing patch.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.444+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6f4022ea-1389-4e5e-a453-11e011340e48", "parentComponentId": null }, { "bbox": { "h": 0.115, "w": 0.764, "x": 0.118, "y": 0.515 }, "kind": "paragraph", "text": "McKinsey Partner Jeff Smith is a senior consultant who worked extensively for both FDA and opioid manufacturers. FDA contracts and proposals describe Mr. Smith as a “core member of McKinsey’s client service team to FDA” since 2007 who has served “on multiple engagements with CDER, the Center for Biologics Evaluation and Research (CBER), the Office of the Commissioner, and the Office of Regulatory Affairs.” Of the 37 FDA contracts for which McKinsey provided staffing information to the Committee, Mr. Smith is staffed on 28 of them.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.444+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7d377382-b9a4-4146-a3e5-367f52c9c279", "parentComponentId": null }, { "bbox": { "h": 0.025, "w": 0.764, "x": 0.118, "y": 0.116 }, "kind": "paragraph", "text": "be in meetings and workshops at FDA the whole day. I come up for air at 6 pm and happy [sic] to take a look at the proposal.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.444+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cc01c0b5-bbc7-4cbd-bd76-b46f5ea26856", "parentComponentId": null }, { "bbox": { "h": 0.07, "w": 0.764, "x": 0.118, "y": 0.392 }, "kind": "paragraph", "text": "A 2014 presentation to Purdue’s new CEO Mark Timney stated that McKinsey would “bring to bear” Mr. Singh’s expertise in “regulatory agencies,” in its work for Purdue, while an email from 2017 referred to “ancient work product” that Mr. Singh and another McKinsey consultant completed for Purdue.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.444+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d0bffd3d-734a-4223-ac25-7dc438dca346", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.764, "x": 0.118, "y": 0.74 }, "kind": "source-note", "text": "17-23 citations listed at the bottom of the page.", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.444+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ed23e7be-a803-4c92-9ebe-bff6cffe9c2a", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.12, "x": 0.118, "y": 0.48 }, "kind": "title", "text": "Jeff Smith", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.444+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0533b622-c25d-4c05-952f-c8046004186c", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 11, "type": "appendix", "title": "This appears to be a page from a legal or investigative report (likely a Congressional or regulatory report) rather than a standard consulting deck, but it is i", "function": "appendix", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "appendix", "functionCanon": { "name": "Appendix", "slug": "appendix", "status": "active", "canonId": "019de52d-138d-750b-83c3-49b4bc7a7a38", "version": 1, "description": null }, "density": "dense", "densityScore": 70, "componentCount": 7, "textChars": 1884, "nDataPoints": 0, "notes": "This appears to be a page from a legal or investigative report (likely a Congressional or regulatory report) rather than a standard consulting deck, but it is inventoried as requested.", "elementsJson": [ "paragraph" ], "confidence": 0.9, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:41.753+00", "seconds": 8.573, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/11", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-11", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": { "h": 0.05, "w": 0.78, "x": 0.11, "y": 0.55 }, "kind": "paragraph", "text": "Former McKinsey Partner Sastry Chilukuri worked extensively for FDA and intermittently on Purdue matters. One McKinsey presentation to FDA in 2015 described him as a “[l]eader of McKinsey’s Healthcare Digital Practice” with “[d]eep FDA IT [information", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.753+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8019fe37-fec0-4eb4-96db-b8395eb6727b", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.11, "y": 0.11 }, "kind": "paragraph", "text": "Smith officially consulted on at least eight separate engagements for Purdue. A 2013 document, which McKinsey submitted to Purdue for use at an industry conference, stated that Mr. Smith possessed “extensive experience working with Purdue over the past 5 years on OxyContin related topics.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.753+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9bbcc767-c3db-4107-af87-f21a00bf52fa", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.11, "y": 0.2 }, "kind": "paragraph", "text": "Mr. Smith specifically dealt with Purdue’s efforts to obtain FDA approval of its opioid products, including projects on (1) securing regulatory approval at FDA of Purdue’s “BuTrans” opioid patch; (2) clinical studies to show the safety of pediatric OxyContin; and (3) preparing Purdue for an FDA Advisory Committee meeting on the safety of OXN Targiniq, another opioid product.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.753+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cb371299-d83a-47dd-bf3d-98796fb72bd3", "parentComponentId": null }, { "bbox": { "h": 0.09, "w": 0.78, "x": 0.11, "y": 0.41 }, "kind": "paragraph", "text": "Even when not officially listed as consulting for projects at Purdue, internal McKinsey documents suggest Mr. Smith advised Purdue executives or discussed Purdue-related matters with other McKinsey colleagues consulting for the opioid manufacturer. For instance, although Mr. Smith did not appear to bill any hours to Purdue in 2016, documents obtained by the Committee show that he was invited to join at least 11 meetings or calls with or about Purdue that year.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.753+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d4c2b256-33ae-4066-90b9-e8b7bb202d9d", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.78, "x": 0.11, "y": 0.3 }, "kind": "paragraph", "text": "By February 2014, Mr. Smith was participating in weekly conference calls with Purdue’s new CEO Mark Timney and a select group of McKinsey consultants. By late 2017, at the personal request of Purdue leadership, Mr. Smith was co-leading a project known as “Project Scottsdale” to transform Purdue’s entire business model. McKinsey held Mr. Smith out to the opioid manufacturer as the “Leader of McKinsey’s service to regulatory agencies globally.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.753+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e43bf096-ea31-4953-9ec7-a85dcfcce302", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.78, "x": 0.11, "y": 0.68 }, "kind": "source-note", "text": "24-30: Citations for the preceding text.", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.753+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d076d7de-eae9-40e5-8e2d-f04439fdc045", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.18, "x": 0.17, "y": 0.51 }, "kind": "title", "text": "Sastry Chilukuri", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.753+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "05985acd-4f0d-428e-a448-9f89007c7b41", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 12, "type": "appendix", "title": "This page appears to be from a formal investigative report or legal document, given the heavy reliance on document reference numbers (MCK-HCOR) as footnotes.", "function": "appendix", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "appendix", "functionCanon": { "name": "Appendix", "slug": "appendix", "status": "active", "canonId": "019de52d-138d-750b-83c3-49b4bc7a7a38", "version": 1, "description": null }, "density": "dense", "densityScore": 62, "componentCount": 6, "textChars": 1109, "nDataPoints": 2, "notes": "This page appears to be from a formal investigative report or legal document, given the heavy reliance on document reference numbers (MCK-HCOR) as footnotes.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:37.198+00", "seconds": 3.597, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/12", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-12", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "McKinsey recommended strategies to 'Turbocharge Purdue’s Sales Engine' and use a 'Wildfire' sales strategy to 'Identify high performance 'champion' reps... and use them to lead their own 'learning teams' of reps.'", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:47+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49a-5aaae9f87afc", "parentComponentId": null }, { "bbox": { "h": 0.3, "w": 0.764, "x": 0.118, "y": 0.615 }, "kind": "disclaimer", "text": "31 MCK-HCOR-0353301, Slide 28. 32 MCK-HCOR-0355686 to MCK-HCOR-0355698... 39 Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty, 234-235 (2021)", "attrs": null, "canon": { "kind": { "name": "Disclaimer", "slug": "disclaimer", "status": "active", "canonId": "91173477-d91f-4024-bbaf-d4f93e3f82dc", "version": 1, "description": "Legal/cautionary text that occupies most of the body of its slide." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.198+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "85baa702-71f5-4337-a47d-6c65e0e045b9", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.764, "x": 0.118, "y": 0.256 }, "kind": "paragraph", "text": "In August 2015, Mr. Chilukuri appears to have assisted a McKinsey consulting team working on an opioid-related matter for the pharmaceutical company Endo International. Documents show that in 2016 Mr. Chilukuri played a key role in pitching a “big data” proposal to Purdue.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.198+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "34c519f6-b509-4cdc-9ca4-3db3305dcf2b", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.764, "x": 0.118, "y": 0.116 }, "kind": "paragraph", "text": "Of the 37 FDA contracts for which McKinsey provided staffing information to the Committee, Mr. Chilukuri is staffed on 7 of them. Mr. Chilukuri also intermittently worked on matters for Purdue and other opioid manufacturers.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.198+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "636a2d06-ec40-4ae2-8963-1035703eca1a", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.764, "x": 0.118, "y": 0.395 }, "kind": "paragraph", "text": "Arnab Ghatak served as one of the primary leaders of McKinsey’s consulting teams at Purdue, leading over 30 engagements between 2004 and 2018. In 2013, Mr. Ghatak co-led the “Evolve to Excellence” project at Purdue.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.198+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "70733c3b-355f-4628-9014-0d4bf52d3b04", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.15, "x": 0.118, "y": 0.365 }, "kind": "title", "text": "Arnab Ghatak", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.198+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f78623b4-51ce-459b-b690-6ada7536345e", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 13, "type": "evidence", "title": "This appears to be a page from a formal investigative report or legal document.", "function": "cite_precedent", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "cite_precedent", "functionCanon": { "name": "Cite precedent", "slug": "cite_precedent", "status": "active", "canonId": "019de52d-142b-714b-86d4-58aad7b568ec", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 86, "componentCount": 10, "textChars": 2537, "nDataPoints": 0, "notes": "This appears to be a page from a formal investigative report or legal document.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:37.844+00", "seconds": 4.088, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/13", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-13", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "The Committee has identified an additional 19 McKinsey consultants, in addition to the three above, who performed work for both FDA and opioid manufacturers.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:47+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b499-ddd03dbdc196", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.78, "x": 0.11, "y": 0.272 }, "kind": "paragraph", "text": "In July 2018, Mr. Ghatak and another McKinsey Senior partner, Martin Elling, discussed destroying documents relating to their work at Purdue. In February 2021, McKinsey stated that it had fired both Mr. Ghatak and Mr. Elling.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.844+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0c64fd0e-36d3-4cca-a4c5-8f58e937d6a9", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.78, "x": 0.11, "y": 0.376 }, "kind": "paragraph", "text": "The Committee has identified an additional 19 McKinsey consultants, in addition to the three above, who performed work for both FDA and opioid manufacturers. Documents obtained by the Committee suggest a pattern of assigning the same consultants to work on McKinsey’s projects for FDA and opioid clients. Two of the consultants identified by the Committee as having worked for both FDA and opioid manufacturers currently serve at the highest levels of the firm, with one sitting on McKinsey’s Client Service Risk Committee and the other on the firm’s Shareholders Council, McKinsey’s equivalent of a board of directors.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.844+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "265609e8-f369-4285-ad22-202e172aff15", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.78, "x": 0.11, "y": 0.515 }, "kind": "paragraph", "text": "Three of these additional McKinsey consultants—all McKinsey partners—are discussed below.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.844+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "601d9ace-f0af-4404-a8bc-b14a06edd594", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.11, "y": 0.603 }, "kind": "paragraph", "text": "Former McKinsey consultant Ted Fuhr worked on five FDA contracts between May 2010 and February 2014 before working on five projects at Purdue Pharma. While working on FDA contracts, Mr. Fuhr appears to have also unofficially consulted on matters related to Purdue. For instance, on May 5, 2010, Mr. Fuhr started an FDA contract “to assist FDA in evaluating existing global product safety efforts and developing and implementing the Global Product", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.844+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "790fcc00-66d9-40b8-b955-06786f003f12", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.11, "y": 0.115 }, "kind": "paragraph", "text": "Mr. Ghatak also consulted for other opioid manufacturers. A 2011 McKinsey presentation stated that he would provide “senior counsel” on a project to “turbocharge” Nucynta, a Johnson & Johnson opioid. In 2015, he appears to have helped implement McKinsey’s strategy for Endo International’s “Sales Force Blitz” of its opioid products.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.844+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e450826e-abf3-44de-8497-c369dd71e872", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.78, "x": 0.11, "y": 0.202 }, "kind": "paragraph", "text": "As described below, in January 2018, Mr. Ghatak contributed to a McKinsey-generated transition memo on the opioid crisis that had been prepared for incoming HHS Secretary Alex Azar, despite consulting for Purdue at the time.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.844+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "eecb533e-40ae-47ae-8933-0f310aa1a9a2", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.78, "x": 0.11, "y": 0.725 }, "kind": "source-note", "text": "40 MCK-HCOR-0202077; MCK-HCOR-0202079, Slide 4. 41 MCK-HCOR-0274099; MCK-HCOR-0297705. 42 MCK-HCOR-0179910. 43 MCK-HCOR-0173795. 44 States Pressure Drugmakers After McKinsey’s $600 Million Opioid Settlement, Wall Street Journal (Feb. 4, 2021). 45 MCK-HCOR-0355686 to MCK-HCOR-0355698 (McKinsey FDA Engagement List); MCK-HCOR-0356043 to MCK-HCOR-0356048 (McKinsey FDA Supplemental Consultant List).", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.844+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7740ab93-c528-4760-a9c7-f6b0f15af481", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.56, "x": 0.22, "y": 0.345 }, "kind": "title", "text": "2. Additional Cross-Over of Consultants", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.844+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "84396d30-c874-40b6-9f99-bf88fd13ae50", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.1, "x": 0.11, "y": 0.568 }, "kind": "title", "text": "Ted Fuhr", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Subtitle", "slug": "subtitle", "status": "active", "canonId": "019de52c-fb09-739d-900c-815b0d9ac526", "version": 1, "description": null }, "framework": null }, "subkind": "subtitle", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.844+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "53576b34-aec7-46c8-990d-563c92f20728", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 14, "type": "setup", "title": "This page appears to be from a legal or investigative report, containing detailed footnotes referencing internal McKinsey documents.", "function": "other", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "other", "functionCanon": { "name": "Other (fallback)", "slug": "other", "status": "active", "canonId": "019de52d-15e1-75bc-99dc-07732380e2ce", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 82, "componentCount": 9, "textChars": 2071, "nDataPoints": 0, "notes": "This page appears to be from a legal or investigative report, containing detailed footnotes referencing internal McKinsey documents.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:42.15+00", "seconds": 8.268, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/14", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-14", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "We found a partner colleague, Ted Fuhr, who may be the right person to provide the Teva point of view. He knows the regulatory space and generics players and has negotiated against Teva.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:48+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49a-d77f6dfe4692", "parentComponentId": null }, { "bbox": { "h": 0.075, "w": 0.764, "x": 0.118, "y": 0.43 }, "kind": "paragraph", "text": "Katy George is one of the most senior partners at McKinsey, currently serving as a \"member of the Shareholders Council, the firm's equivalent of the board of directors, and the firm's 15-person global leadership team.\"53 From April 2010 to December 2011, Ms. George worked on eight separate FDA engagements, including two projects helping set up a system to track and trace the safety of dangerous drugs such as opioids.54", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.15+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "504b2595-aab4-4cea-a23f-d3917d89ca11", "parentComponentId": null }, { "bbox": { "h": 0.105, "w": 0.764, "x": 0.118, "y": 0.158 }, "kind": "paragraph", "text": "In January 2014, Mr. Fuhr worked on a project supporting the FDA's Office of Generic Drugs at a time when Purdue was facing significant competition from a generic opioid produced by Teva Pharmaceuticals after an adverse court ruling on several patents, threatening OxyContin's market share.48 On January 15, 2014, a McKinsey partner emailed other consultants that \"Teva would still need to submit an ANDA [abbreviated new drug application] for a tamper-resistant product and get it approved\" by FDA.49", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.15+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "58689ac9-98d1-4365-b5c4-9b72b5fa22f0", "parentComponentId": null }, { "bbox": { "h": 0.075, "w": 0.764, "x": 0.118, "y": 0.27 }, "kind": "paragraph", "text": "One week later, the same McKinsey consultant emailed a senior executive at Purdue and introduced Mr. Fuhr: \"We found a partner colleague, Ted Fuhr, who may be the right person to provide the Teva point of view. He knows the regulatory space and generics players and has negotiated against Teva.\"50 Mr. Fuhr's project at FDA lasted several more weeks after this email, ending on February 3, 2014.51", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.15+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7ae2d2c2-801f-44f1-a4ef-3c1fa4e7e446", "parentComponentId": null }, { "bbox": { "h": 0.045, "w": 0.764, "x": 0.118, "y": 0.116 }, "kind": "paragraph", "text": "Safety Plan.46 Eight days later, on May 13, 2010, Mr. Fuhr was invited to a call with other McKinsey consultants to discuss a request from Purdue, for a matter on which he was not staffed.47", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.15+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8c5cd5f1-a950-4d6b-a4a7-d21d4ac7c881", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.764, "x": 0.118, "y": 0.355 }, "kind": "paragraph", "text": "After this introduction, Mr. Fuhr was staffed on five official projects at Purdue Pharma spanning from May 2015 to September 2017.52", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.15+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "bf2909f4-144f-4548-b131-83938733c9ef", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "We found a partner colleague, Ted Fuhr, who may be the right person to provide the Teva point of view. He knows the regulatory space and generics players and has negotiated against Teva.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:48+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49a-db464a2489dd", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.764, "x": 0.118, "y": 0.55 }, "kind": "source-note", "text": "46-54 Footnotes detailing document references.", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.15+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "31f895d4-ed26-4abc-9bae-b4dfc2f6c86f", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.15, "x": 0.118, "y": 0.4 }, "kind": "title", "text": "Katy George", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.15+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "37fb7da9-daf2-4e34-91e3-2172ab109cc3", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 15, "type": "setup", "title": "This page appears to be an excerpt from a formal report or investigative document, containing narrative text and extensive footnotes.", "function": "summarize", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "summarize", "functionCanon": { "name": "Summarize", "slug": "summarize", "status": "active", "canonId": "019de52d-1541-704f-b86f-bf7b75056373", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 75, "componentCount": 8, "textChars": 1441, "nDataPoints": 0, "notes": "This page appears to be an excerpt from a formal report or investigative document, containing narrative text and extensive footnotes.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:54.779+00", "seconds": 20.729, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/15", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-15", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": { "h": 0.25, "w": 0.8, "x": 0.1, "y": 0.68 }, "kind": "disclaimer", "text": "55 MCK-HCOR-0086036; MCK-HCOR-0172253; MCK-HCOR-0155555, Pages 14-15; MCK-HCOR-0339527; MCK-HCOR-0172451; MCK-HCOR-0174776; MCK-HCOR-0172142. 56 MCK-HCOR-0174550 to MCK-HCOR-0174698 (McKinsey Purdue Engagement List)...", "attrs": null, "canon": { "kind": { "name": "Disclaimer", "slug": "disclaimer", "status": "active", "canonId": "91173477-d91f-4024-bbaf-d4f93e3f82dc", "version": 1, "description": "Legal/cautionary text that occupies most of the body of its slide." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:54.779+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c9b48ec8-0d79-44a0-969c-df4623dd2b8d", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.8, "x": 0.1, "y": 0.26 }, "kind": "paragraph", "text": "Nora Gardner is among the most senior partners at McKinsey. She serves as the Managing Partner of McKinsey’s Washington D.C. office and, according to documents provided to the Committee, is a member of the firm’s Client Service Risk Committee.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:54.779+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0add9d4e-7f93-4000-b1f3-ec4dbb6ff558", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.8, "x": 0.1, "y": 0.46 }, "kind": "paragraph", "text": "Documents indicate that during this time, Ms. Gardner was also unofficially participating on Purdue matters. Ms. Gardner received invitations for 15 calls and meetings with Purdue between January 15, 2015, and April 1, 2015...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:54.779+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0b5605fe-d799-49a6-89b3-62db82126fae", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.8, "x": 0.1, "y": 0.35 }, "kind": "paragraph", "text": "From January 2018 to March 2019, Ms. Gardner consulted on four projects at FDA, including on a project to modernize new drug programs. In January 2018, Ms. Gardner began a project at FDA to \"Design and implement the future state operating model...\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:54.779+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "323aa942-14a9-4442-ba45-c200bd9ffee1", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.8, "x": 0.1, "y": 0.1 }, "kind": "paragraph", "text": "Ms. George first staffed a Purdue project in 2004 and appears to have intermittently assisted the manufacturer over the next 12 years. For instance, Ms. George appeared to brief Richard Sackler on foreign business opportunities in 2007...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:54.779+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4fdd37ad-f86c-4b5f-b6be-372c735bcc23", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.8, "x": 0.1, "y": 0.6 }, "kind": "paragraph", "text": "The Committee has identified at least 16 additional consultants who worked for FDA and opioid manufacturers between 2008 and 2022. The Committee has outlined the contracts for 15 of these consultants falling below the full partner level...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:54.779+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "95567458-e540-403a-914d-65757a0e37a7", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.2, "x": 0.1, "y": 0.56 }, "kind": "title", "text": "Other Consultants", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:54.779+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "63490f72-039f-4f8e-b8e9-1fab52a4ffbe", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.2, "x": 0.1, "y": 0.22 }, "kind": "title", "text": "Nora Gardner", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:54.779+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ea13985a-f92c-46d2-a9b6-b8836a4b870e", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 16, "type": "evidence", "title": "The slide highlights potential conflicts of interest by showing consultants who worked for both regulatory bodies and the companies they regulated.", "function": "cite_precedent", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "cite_precedent", "functionCanon": { "name": "Cite precedent", "slug": "cite_precedent", "status": "active", "canonId": "019de52d-142b-714b-86d4-58aad7b568ec", "version": 1, "description": null }, "density": "balanced", "densityScore": 48, "componentCount": 5, "textChars": 584, "nDataPoints": 45, "notes": "The slide highlights potential conflicts of interest by showing consultants who worked for both regulatory bodies and the companies they regulated.", "elementsJson": [ "paragraph", "comparison_table", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:36.434+00", "seconds": 2.302, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/16", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-16", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "McKinsey staffed several of these consultants on projects at FDA and Purdue simultaneously.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:49+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49b-1d8746fcdf83", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.11, "y": 0.11 }, "kind": "paragraph", "text": "representing contracts performed for Purdue and FDA. 62 Several of these consultants also likely participated on matters for Purdue and other opioid manufacturers despite not being listed in official engagement lists.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:36.434+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "fec14702-5855-4cc3-98db-58432cebd464", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.78, "x": 0.11, "y": 0.76 }, "kind": "source-note", "text": "Footnotes 62-65 detailing the source of the data and specific consultant engagement details.", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:36.434+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "3476114b-72d4-4dfe-bb67-03f5531efcec", "parentComponentId": null }, { "bbox": { "h": 0.46, "w": 0.42, "x": 0.29, "y": 0.27 }, "kind": "table", "text": "Table showing 15 consultants and their engagement with FDA and Purdue (and Mallinckrodt)", "attrs": null, "canon": { "kind": { "name": "Table", "slug": "table", "status": "active", "canonId": "019de52c-f9c8-7148-8119-eaac9594cd28", "version": 1, "description": "Tabular data layout." }, "tool": null, "subkind": { "name": "Data table", "slug": "data", "status": "active", "canonId": "019de52d-02d5-75b8-8abf-88e92bf63569", "version": 1, "description": null }, "framework": null }, "subkind": "data", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:36.434+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7270cfc7-c785-4e31-9b99-744f23f2eaf5", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.5, "x": 0.25, "y": 0.23 }, "kind": "title", "text": "Additional Known McKinsey Consultants Serving FDA and Opioid Manufacturers Between 2008 and 2021", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:36.434+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9c2d5414-d206-487f-9cbd-742e603c14ca", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 17, "type": "setup", "title": "Contains extensive footnotes documenting specific internal McKinsey engagement lists and correspondence.", "function": "summarize", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "summarize", "functionCanon": { "name": "Summarize", "slug": "summarize", "status": "active", "canonId": "019de52d-1541-704f-b86f-bf7b75056373", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 86, "componentCount": 9, "textChars": 1681, "nDataPoints": 2, "notes": "Contains extensive footnotes documenting specific internal McKinsey engagement lists and correspondence.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:38.148+00", "seconds": 3.964, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/17", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-17", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "All of the 37 FDA contracts for which McKinsey provided staffing information to the Committee were staffed by at least one McKinsey consultant who also consulted for Purdue.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:49+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49b-648d261d1dc9", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "Contract Value: $1,799,534", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:49+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49b-689f0f461b72", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.7, "x": 0.15, "y": 0.17 }, "kind": "paragraph", "text": "All of the 37 FDA contracts for which McKinsey provided staffing information to the Committee were staffed by at least one McKinsey consultant who also consulted for Purdue.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:38.148+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a87a4ffd-d80e-405d-835c-19ee845b5f3e", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.7, "x": 0.15, "y": 0.4 }, "kind": "paragraph", "text": "The first OSE contract, worth $1,799,534, charged McKinsey with developing a new concept of operations for the Office. The contract was staffed by nine McKinsey consultants. Four of the nine consultants on the contract were also consulting for Purdue during this time, including partner Jeff Smith. A fifth McKinsey consultant working on this OSE project, Navjot Singh, had previously participated on Purdue matters, and documents suggest he may have been participating on Purdue and private sector clients on FDA-related issues during this time.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:38.148+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d93ec824-682d-403f-b22b-cb5d5d8a51a7", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.7, "x": 0.15, "y": 0.31 }, "kind": "paragraph", "text": "CDER's Office of Surveillance and Epidemiology (OSE) evaluates the safety profiles of drugs available to American consumers, maintaining a system of post-marketing surveillance programs to identify adverse events that did not appear during the drug development process. McKinsey undertook two contracts related to drug safety at OSE between 2011 and 2012.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:38.148+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e1a36cc6-6657-4928-9e57-29a7e6c7e20b", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.7, "x": 0.15, "y": 0.23 }, "kind": "paragraph", "text": "The Committee has identified four illustrative categories of FDA contracts that raise particular conflict of interest concerns.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:38.148+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "edca3003-935a-4ce7-9326-ea2e89cb00fc", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.7, "x": 0.15, "y": 0.56 }, "kind": "source-note", "text": "66-70: Detailed references to McKinsey engagement lists and Committee correspondence.", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:38.148+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "51c73ffe-0260-47d3-b550-397a3ef8a9e3", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.7, "x": 0.15, "y": 0.11 }, "kind": "title", "text": "3. McKinsey's FDA Contracts Overlapped with McKinsey's Work for Opioid Manufacturers, Creating Significant Conflicts of Interest", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:38.148+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "fee02f93-62c1-47ec-a059-5615cd7fd4fd", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.7, "x": 0.15, "y": 0.28 }, "kind": "title", "text": "i. FDA Office of Surveillance and Epidemiology Contracts (2011-2012)", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Subtitle", "slug": "subtitle", "status": "active", "canonId": "019de52c-fb09-739d-900c-815b0d9ac526", "version": 1, "description": null }, "framework": null }, "subkind": "subtitle", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:38.148+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "63710d83-d394-4743-ae1c-525598f16b90", "parentComponentId": null } ], "metrics": [ { "metricRaw": "Contract Value", "numberRaw": "$1,799,534", "numberKind": "money", "actionTitle": "McKinsey's FDA Contracts Overlapped with McKinsey's Work for Opioid Manufacturers, Creating Significant Conflicts of Interest", "calloutText": "All of the 37 FDA contracts for which McKinsey provided staffing information to the Committee were staffed by at least one McKinsey consultant who also consulted for Purdue.", "numberScale": null, "numberValue": 1.799, "metricFamily": "other", "numberCurrency": "$" } ], "tools": [], "frameworks": [], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 18, "type": "appendix", "title": "This page appears to be an excerpt from a report or legal document, containing narrative text and extensive footnotes.", "function": "appendix", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "appendix", "functionCanon": { "name": "Appendix", "slug": "appendix", "status": "active", "canonId": "019de52d-138d-750b-83c3-49b4bc7a7a38", "version": 1, "description": null }, "density": "balanced", "densityScore": 46, "componentCount": 5, "textChars": 846, "nDataPoints": 0, "notes": "This page appears to be an excerpt from a report or legal document, containing narrative text and extensive footnotes.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:36.978+00", "seconds": 2.698, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/18", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-18", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": { "h": 0.15, "w": 0.76, "x": 0.12, "y": 0.45 }, "kind": "paragraph", "text": "Documents show that while working on the first FDA OSE contract, McKinsey consultant Jeff Smith worked on at least four separate projects at Purdue, including regulatory matters before FDA. One project involved the effectiveness of REMS for OxyContin...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:36.978+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "51cfbfef-847a-4497-be10-24d2df7afa02", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.03, "x": 0.48, "y": 0.94 }, "kind": "paragraph", "text": "18", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:36.978+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c7830b2c-58f6-435f-9e91-53c6bd7e4b6d", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.76, "x": 0.12, "y": 0.11 }, "kind": "paragraph", "text": "McKinsey's contract with OSE detailed how Congress had provided “FDA with several major new post-marketing authorities, including the authority to require a Risk Evaluation and Mitigation Strategy (REMS) for new and existing products if deemed necessary.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:36.978+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ca7a4f61-26b5-4018-ac38-c36eac68e4c4", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.76, "x": 0.12, "y": 0.28 }, "kind": "paragraph", "text": "In early 2009, FDA had notified certain opioids manufacturers that their drugs would need a REMS to ensure that the benefits of the drugs continue to outweigh the risks. In the same year, McKinsey advised Purdue on a strategy to weaken the proposed REMS plan...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:36.978+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d55ed8d0-1442-4b90-aae4-440a63b55cd3", "parentComponentId": null }, { "bbox": { "h": 0.28, "w": 0.76, "x": 0.12, "y": 0.63 }, "kind": "source-note", "text": "Footnotes 71 through 77 detailing document references and external sources.", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:36.978+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4e30582c-60ff-4f86-93c0-f92a343cfb99", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 19, "type": "evidence", "title": "The slide highlights potential conflicts of interest by mapping concurrent consulting engagements and meetings.", "function": "illustrate_case", "rawType": "appendix_data", "block": null, "metadata": { "slideType": "appendix_data", "slideTypeCanon": { "name": "Appendix data", "slug": "appendix_data", "status": "active", "canonId": "019de52d-078a-745b-9ee4-c15f2f539acd", "version": 1, "description": null }, "function": "illustrate_case", "functionCanon": { "name": "Illustrate case", "slug": "illustrate_case", "status": "active", "canonId": "019de52d-13b4-772c-bb73-1873612a7463", "version": 1, "description": null }, "density": "dense", "densityScore": 51, "componentCount": 6, "textChars": 726, "nDataPoints": 0, "notes": "The slide highlights potential conflicts of interest by mapping concurrent consulting engagements and meetings.", "elementsJson": [ "paragraph", "timeline_visual", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:37.421+00", "seconds": 2.982, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/19", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-19", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "McKinsey frequently cross-staffed Mr. Smith on FDA and Purdue consulting projects.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:49+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49b-356047095dc0", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.76, "x": 0.12, "y": 0.38 }, "kind": "chart", "text": "Timeline of FDA and Purdue contracts and meetings", "attrs": null, "canon": { "kind": { "name": "Chart", "slug": "chart", "status": "active", "canonId": "019de52c-f9a0-76ef-adc6-0b859109d1f8", "version": 1, "description": "Quantitative chart." }, "tool": null, "subkind": null, "framework": null }, "subkind": "timeline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.421+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5323b4dd-a13f-462c-acf7-016edfdfbab9", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.76, "x": 0.12, "y": 0.235 }, "kind": "paragraph", "text": "McKinsey frequently cross-staffed Mr. Smith on FDA and Purdue consulting projects. The below graphic depicts the overlap between Mr. Smith's known FDA and Purdue consulting work between 2010 and 2013.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.421+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2250399b-6489-4cd8-96da-670b01d98447", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.76, "x": 0.12, "y": 0.115 }, "kind": "paragraph", "text": "a hair testing program at Purdue designed to demonstrate the safety of a newly approved abuse-deterrent formulation of OxyContin...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.421+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b866407c-5bfc-490f-828c-fde7365e17e0", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.76, "x": 0.12, "y": 0.72 }, "kind": "source-note", "text": "78 MCK-HCOR-0018792, Slide 126. 79 MCK-HCOR-0018792, Slide 163. 80 This timeline represents the engagements McKinsey partner Jeff Smith was involved in at both Purdue and FDA between 2010 and 2013...", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.421+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cba73ad4-543f-46a7-a5c8-ceeaba2d7c3f", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.36, "x": 0.32, "y": 0.325 }, "kind": "title", "text": "McKinsey Partner Jeff Smith's FDA & Purdue Contracts and Meetings", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.421+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "054ba21a-d574-4dae-ab47-5d8acb3c5e24", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [ { "matchId": "c7354210-1e86-4b62-bf44-d17c15978f6a", "evidence": "Timeline visualization of overlapping project durations", "framework": null, "confidence": 0.9, "extraction": { "at": "2026-05-02 19:14:37.421+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 19, "frameworkName": "gantt-chart" } ], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 20, "type": "evidence", "title": "This appears to be a page from a legal or investigative report (e.g., a congressional report) rather than a standard consulting deck.", "function": "cite_precedent", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "cite_precedent", "functionCanon": { "name": "Cite precedent", "slug": "cite_precedent", "status": "active", "canonId": "019de52d-142b-714b-86d4-58aad7b568ec", "version": 1, "description": null }, "density": "balanced", "densityScore": 38, "componentCount": 4, "textChars": 776, "nDataPoints": 0, "notes": "This appears to be a page from a legal or investigative report (e.g., a congressional report) rather than a standard consulting deck.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 0.9, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:37.001+00", "seconds": 2.562, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/20", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-20", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "Documents show Purdue executives were focused on defeating FDA safety measures for OxyContin, viewing the effort as potentially 'necessary to save the business.'", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:49+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49b-c38ab8167d0c", "parentComponentId": null }, { "bbox": { "h": 0.65, "w": 0.78, "x": 0.11, "y": 0.11 }, "kind": "paragraph", "text": "One of the other consultants working on the OSE contract with Mr. Smith was Joachim Bleys, who is currently a partner at McKinsey. Documents show that Mr. Bleys worked on eight FDA engagements between 2010 and 2012...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.001+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6c073c83-05e0-4a55-977b-01eef102edc6", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Purdue executives were focused on defeating FDA safety measures for OxyContin, viewing the effort as potentially 'necessary to save the business.'", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:49+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49b-c54fbd4e78d4", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.78, "x": 0.11, "y": 0.68 }, "kind": "source-note", "text": "81 McKinsey & Company, A New Portfolio Model For Biotech... 82 MCK-HCOR-0355686... 83 MCK-HCOR-0334973... 84 MCK-HCOR-0340667... 85 MCK-HCOR-0018792... 86 MCK-HCOR-0174550... 87 MCK-HCOR-0020344... 88 Id.; MCK-HCOR-0020425... 89 Patrick Radden Keefe...", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.001+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "24cdd4aa-ef3a-4cfa-b10d-dc2fcab33996", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 21, "type": "appendix", "title": "This appears to be a page from a formal report or legal document, containing footnotes and narrative text.", "function": "appendix", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "appendix", "functionCanon": { "name": "Appendix", "slug": "appendix", "status": "active", "canonId": "019de52d-138d-750b-83c3-49b4bc7a7a38", "version": 1, "description": null }, "density": "dense", "densityScore": 54, "componentCount": 5, "textChars": 2342, "nDataPoints": 0, "notes": "This appears to be a page from a formal report or legal document, containing footnotes and narrative text.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:38.382+00", "seconds": 3.782, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/21", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-21", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "McKinsey performed three contracts on the FDA Sentinel Initiative at the same time the company was consulting with opioid manufacturers on related issues, often with overlapping consultants, which increased the risk that FDA information might be shared with private sector clients.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:49+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49b-0a14d4490f01", "parentComponentId": null }, { "bbox": { "h": 0.335, "w": 0.766, "x": 0.117, "y": 0.116 }, "kind": "paragraph", "text": "stakeholders\" including 17 FDA officials in the Office of Regulatory Affairs and five officials in CDER.90 Navjot Singh, who was also working with Mr. Smith on the FDA OSE contract, also appears to have informally advised McKinsey consultants serving private sector clients at this time, including Purdue. In February 2011, a McKinsey consultant emailed Mr. Singh stating that they were \"working through\" several \"FDA issues\" for a private sector client and added: \"Would be great to get the Regulatory pov [point of view] and expertise in the Purdue CST [client service team].\" Mr. Singh responded: \"Look forward to it. Depending on calendars 2 other[s] to include in the mix here are Jeff Smith and Pasha Saraf.\"91 Pasha Saraf was a key McKinsey consultant working for Purdue.92 It is unclear what \"FDA issue\" Mr. Singh offered his expertise on, or what other material he and the McKinsey consultants may have discussed on the call.93 On August 30, 2011, McKinsey was awarded a second contract by FDA to implement the new model governing OSE's portfolio. The second OSE contract, like the first, referenced REMS and CDER and OSE's responsibility over drug safety.94 Jeff Smith and Navjot Singh, along with two other McKinsey consultants, co-led this second engagement.95", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:38.382+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7740ebf4-39f1-47d7-9eaa-792a97a8aa43", "parentComponentId": null }, { "bbox": { "h": 0.165, "w": 0.766, "x": 0.117, "y": 0.501 }, "kind": "paragraph", "text": "In 2008, FDA created the Sentinel Initiative to assess post-approval drug safety signals and \"monitor the safety of FDA-regulated medical products, including drugs, vaccines, biologics, and medical devices.\"96 Sentinel has since become \"a core component of the agency's evolving safety surveillance system,\" and \"Sentinel data have informed many regulatory decisions made by the Center for Drug Evaluation and Research.\"97 McKinsey performed three contracts on the FDA Sentinel Initiative at the same time the company was consulting with opioid manufacturers on related issues, often with overlapping consultants, which increased the risk that FDA information might be shared with private sector clients.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:38.382+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "de849a5c-2bfa-4531-be49-522ffd825928", "parentComponentId": null }, { "bbox": { "h": 0.205, "w": 0.766, "x": 0.117, "y": 0.698 }, "kind": "source-note", "text": "90-97 Footnotes detailing sources for the text.", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:38.382+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c158a922-0bd3-43eb-b41a-11a4e011e65a", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.53, "x": 0.235, "y": 0.468 }, "kind": "title", "text": "ii. FDA Sentinel Contracts (2014-2018)", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:38.382+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "153072e0-d835-4703-a819-2a7b98685eab", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 22, "type": "evidence", "title": "The slide serves as a disclosure/evidence page for a report, citing specific internal documents.", "function": "cite_precedent", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "cite_precedent", "functionCanon": { "name": "Cite precedent", "slug": "cite_precedent", "status": "active", "canonId": "019de52d-142b-714b-86d4-58aad7b568ec", "version": 1, "description": null }, "density": "dense", "densityScore": 57, "componentCount": 6, "textChars": 800, "nDataPoints": 1, "notes": "The slide serves as a disclosure/evidence page for a report, citing specific internal documents.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:37.198+00", "seconds": 2.572, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/22", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-22", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "In total, FDA has paid McKinsey $3,910,863 for its work on the Sentinel Initiative.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:50+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49c-00c9d4c3b404", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "Total payments: $3,910,863", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:50+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49c-062311281959", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.7, "x": 0.15, "y": 0.41 }, "kind": "paragraph", "text": "Documents obtained by the Committee show that Jeff Smith co-led all three Sentinel contracts... Mr. Smith and Mr. Chilukuri appear to have participated on opioid manufacturer matters at the same time...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.198+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "726faf76-f9b8-4c39-88e0-b02cce65d3ed", "parentComponentId": null }, { "bbox": { "h": 0.22, "w": 0.7, "x": 0.15, "y": 0.12 }, "kind": "paragraph", "text": "On the first contract in 2014, FDA tasked McKinsey with analyzing the “strengths, limitations and appropriate use” of Sentinel... In total, FDA has paid McKinsey $3,910,863 for its work on the Sentinel Initiative.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.198+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cbd7f9da-0c5e-41fc-a70a-03d85a1873fc", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.7, "x": 0.15, "y": 0.68 }, "kind": "source-note", "text": "98 MCK-HCOR-0355652, Page 4. 99 MCK-HCOR-0351909, Pages 8-9. 100 Id. 101 MCK-HCOR-0355686 to MCK-HCOR-0355698 (McKinsey FDA Engagement List). 102 Dr. Richard Platt et. al... 103-106 Citations.", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.198+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "27b87e45-dfa3-4773-a008-a6c9fda97571", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.7, "x": 0.15, "y": 0.35 }, "kind": "title", "text": "1. Overlap of Consultants Between FDA's Sentinel Initiative and Opioid Manufacturers", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.198+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "71c11cba-1043-49e7-b16f-50798d827867", "parentComponentId": null } ], "metrics": [ { "metricRaw": "Total payments", "numberRaw": "$3,910,863", "numberKind": "money", "actionTitle": "Overlap of Consultants Between FDA's Sentinel Initiative and Opioid Manufacturers", "calloutText": "In total, FDA has paid McKinsey $3,910,863 for its work on the Sentinel Initiative.", "numberScale": null, "numberValue": 3.91, "metricFamily": "other", "numberCurrency": "$" } ], "tools": [], "frameworks": [], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 23, "type": "setup", "title": "This appears to be a page from a formal investigative report or legal document.", "function": "summarize", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "summarize", "functionCanon": { "name": "Summarize", "slug": "summarize", "status": "active", "canonId": "019de52d-1541-704f-b86f-bf7b75056373", "version": 1, "description": null }, "density": "dense", "densityScore": 70, "componentCount": 7, "textChars": 1804, "nDataPoints": 0, "notes": "This appears to be a page from a formal investigative report or legal document.", "elementsJson": [ "paragraph", "quote_block", "footnote" ], "confidence": 0.9, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:41.517+00", "seconds": 6.701, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/23", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-23", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "Jeff - think it would be great for you or Sastry to talk about our work w FDA, specifically sentinel which I think would be v useful for them in opioids.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:49+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49b-811019825828", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.7, "x": 0.15, "y": 0.8 }, "kind": "disclaimer", "text": "107 MCK-HCOR-0125427, Slide 6.\n108 MCK-HCOR-0174550 to MCK-HCOR-0174698 (McKinsey Purdue Engagement List).\n109 Real World Evidence reflects data regarding the usage and potential benefits or risks of a medical product derived outside the clinical trial process from sources such as billing records, patient data, and disease registries. Food and Drug Administration, Real-World Evidence (online at www.fda.gov/science-research/science-and-research-special-topics/real-world-evidence) (accessed on Mar. 16, 2022).", "attrs": null, "canon": { "kind": { "name": "Disclaimer", "slug": "disclaimer", "status": "active", "canonId": "91173477-d91f-4024-bbaf-d4f93e3f82dc", "version": 1, "description": "Legal/cautionary text that occupies most of the body of its slide." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.517+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d9c09a32-e0b5-4d44-acb7-39b8c03aa2c1", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.7, "x": 0.15, "y": 0.36 }, "kind": "paragraph", "text": "In May 2016, while working on the FDA's Sentinel program, Mr. Smith assisted a team of McKinsey consultants in preparing a new proposal to submit to Purdue for a project designed to provide \"real world evidence\" of OxyContin's safety, through which McKinsey would provide data on the drug's safety from patient-generated and public health data outside of clinical trials.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.517+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "30724d7b-c2dc-42c2-829c-3969f5af0b59", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.7, "x": 0.15, "y": 0.27 }, "kind": "paragraph", "text": "Documents obtained by the Committee reveal that McKinsey consultants representing Purdue sought out information from consultants representing FDA, who may have shared details about the FDA Sentinel Initiative with Purdue with the goal of securing a contract to track OxyContin's safety.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.517+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "86df7ed7-86f6-4d6a-97cc-8eaec12b0058", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.7, "x": 0.15, "y": 0.59 }, "kind": "quote", "text": "\"Jeff - think it would be great for you or Sastry to talk about our work w FDA, specifically sentinel which I think would be v useful for them in opioids.\"\n— A. Ghatak, McKinsey Partner", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Pull quote", "slug": "pull-quote", "status": "active", "canonId": "019de52c-fbf9-76fe-97e1-a0b7540445c9", "version": 1, "description": null }, "framework": null }, "subkind": "pull-quote", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.517+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "47ba5794-8358-4214-9b13-58adf483721b", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Jeff - think it would be great for you or Sastry to talk about our work w FDA, specifically sentinel which I think would be v useful for them in opioids. — A. Ghatak, McKinsey Partner", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:49+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49b-879fc8adb26c", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.7, "x": 0.15, "y": 0.22 }, "kind": "title", "text": "2. Increased Risk that McKinsey Shared Information About FDA's Sentinel Contract to Gain Additional Work at Purdue", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.517+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7a4c2ec0-1d6b-40b0-b17a-b66f34265496", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 24, "type": "evidence", "title": "The slide is an embedded image within a larger document, likely a report or legal filing.", "function": "illustrate_case", "rawType": "case_study", "block": null, "metadata": { "slideType": "case_study", "slideTypeCanon": { "name": "Case study", "slug": "case_study", "status": "active", "canonId": "019de52d-0b95-7344-8090-926f3b8e92c8", "version": 1, "description": null }, "function": "illustrate_case", "functionCanon": { "name": "Illustrate case", "slug": "illustrate_case", "status": "active", "canonId": "019de52d-13b4-772c-bb73-1873612a7463", "version": 1, "description": null }, "density": "balanced", "densityScore": 43, "componentCount": 5, "textChars": 699, "nDataPoints": 0, "notes": "The slide is an embedded image within a larger document, likely a report or legal filing.", "elementsJson": [ "paragraph", "screenshot", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:37.498+00", "seconds": 2.674, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/24", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-24", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "The presentation highlighted how McKinsey's work for FDA gave it a \"[c]lear understanding of priority use cases for postmarketing surveillance (including alignment around value, trust, and results that affect-regulatory decision making).\"", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:49+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49b-997ca4fe2885", "parentComponentId": null }, { "bbox": { "h": 0.3, "w": 0.55, "x": 0.22, "y": 0.39 }, "kind": "diagram", "text": "Flowchart showing FDA Scientist Safety Reviewers, Sentinel Lead Teams, MSOC, and Data Partner interactions.", "attrs": null, "canon": { "kind": { "name": "Diagram", "slug": "diagram", "status": "active", "canonId": "019de52c-f9f0-734a-81de-15382ff28c65", "version": 1, "description": "Schematic or relational diagram." }, "tool": null, "subkind": { "name": "Process flow", "slug": "process", "status": "active", "canonId": "019de52d-039c-718f-ad3a-efe9c4b3c838", "version": 1, "description": null }, "framework": null }, "subkind": "process", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.498+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b3289f72-5a6f-4cb4-adae-83dedd3c7510", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.7, "x": 0.15, "y": 0.16 }, "kind": "paragraph", "text": "As part of its May 2016 proposal to Purdue, McKinsey consultants prepared and circulated a PowerPoint presentation showcasing its work on the FDA Sentinel Initiative...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.498+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "57facc2a-1fb9-449d-95af-58ff915c359f", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.7, "x": 0.15, "y": 0.84 }, "kind": "source-note", "text": "110 MCK-HCOR-0278700. 111 MCK-HCOR-0326970; MCK-HCOR-0331848. 112 MCK-HCOR-0331545, Pages 18, 19, and 48; MCK-HCOR-0332150, Pages 17, 18, and 47.", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.498+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "04bbbfea-4bd5-4358-a267-f58f04f60339", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.4, "x": 0.22, "y": 0.36 }, "kind": "title", "text": "Overview of current state operating model", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:37.498+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5c4db0c9-cdc3-46bd-8bf1-271bc62a5e6d", "parentComponentId": null } ], "metrics": [], "tools": [ { "tool": { "name": "Process flow", "slug": "process-flow", "status": "active", "bestFor": null, "canonId": "019dd9e1-4dca-76bc-8135-401836a1c4c0", "version": 1, "bodyDocId": null, "description": "Workflow, steps, sequential diagram.", "familyLabel": null, "categoryName": null, "categorySlug": null }, "agent": null, "layer": "slide", "agents": null, "matchId": "d44cb24d-2475-4a54-b3e8-85f4b917ad49", "evidence": "Flowchart showing FDA Scientist Safety Reviewers, Sentinel Lead Teams, MSOC, and Data Partner interactions.", "pageRefs": null, "priority": null, "whenToUse": null, "confidence": 0.7, "extraction": { "at": "2026-07-16 21:17:55.62966+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 24, "whyItWorks": null, "antipattern": null, "cardinality": "common", "narrativePurpose": null } ], "frameworks": [], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } }, { "to": 40, "from": 24, "loop": { "name": "51_voice_of_customer", "slug": "51-voice-of-customer", "status": "active", "bestFor": "Product strategy, customer experience, market research", "canonId": "019dd956-7aaf-750b-950b-af0df38f5266", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "What Customers Say (Verbatim) -> The Pattern Across Voices -> The Insight -> The Response", "description": "Let customer quotes and feedback drive the narrative and validate the insight", "familyLabel": null }, "matchId": "308c22ef-34f3-45b8-b50d-c273c6edeb88", "evidence": "The document presents the concerns of regulatory bodies through examples of McKinsey's actions and lack of disclosure.", "position": 1, "objective": "What are the concerns of regulatory bodies regarding McKinsey's conflicts of interest?", "confidence": 0.6, "extraction": { "at": "2026-07-16 21:07:34.52569+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 25, "type": "setup", "title": "This page appears to be an excerpt from a legal or investigative report, containing footnotes and narrative text.", "function": "other", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "other", "functionCanon": { "name": "Other (fallback)", "slug": "other", "status": "active", "canonId": "019de52d-15e1-75bc-99dc-07732380e2ce", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 77, "componentCount": 8, "textChars": 1764, "nDataPoints": 0, "notes": "This page appears to be an excerpt from a legal or investigative report, containing footnotes and narrative text.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:39.47+00", "seconds": 4.563, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/25", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-25", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": { "h": 0.05, "w": 0.78, "x": 0.11, "y": 0.63 }, "kind": "paragraph", "text": "From May 2016 to March 2017, McKinsey served as subcontractors for an FDA contract which had been awarded to MITRE—a not-for-profit organization that manages federally funded research and development centers. Four of the six McKinsey consultants staffed on the", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:39.47+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "415bf05f-2e29-4711-b79c-03787eab19b7", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.78, "x": 0.11, "y": 0.11 }, "kind": "paragraph", "text": "These slides did not appear in later versions of the presentation, although the presentation continued to refer to McKinsey's work for the FDA. It is unclear whether these slides were ever shown to Purdue.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:39.47+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6560f3cf-1a9b-4f79-a3f3-e0ff65006616", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.78, "x": 0.11, "y": 0.18 }, "kind": "paragraph", "text": "Separately, McKinsey appears to have influenced FDA's official statements about Sentinel in between its second and third Sentinel contracts. On February 6, 2018, between McKinsey's second and third contracts on the Sentinel Initiative, then-FDA Commissioner Scott Gottlieb gave a public speech suggesting the Sentinel System could potentially be used to provide data on the long-term efficacy of opioids.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:39.47+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "83fa9bba-0a49-4bc9-8592-de3905678540", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.11, "y": 0.37 }, "kind": "paragraph", "text": "Two days later, Mr. Smith complained by email to a colleague that Mr. Chilukuri had overrepresented the capabilities of the Sentinel System and told a \"client\" (possibly a reference to FDA) that Sentinel can be \"used to assess the efficacy of opioids.\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:39.47+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a6bbd325-8eef-4cfd-80e7-0f9559b582e8", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.11, "y": 0.51 }, "kind": "paragraph", "text": "Four months later, in June 2018, Mr. Smith and Mr. Singh began work on McKinsey's third FDA Sentinel contract, which tasked McKinsey with conducting \"activities to define current priorities, assess long-term strategic themes, prioritize strategic options and articulate a five-year strategic plan into an FDA branded report for public release.\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:39.47+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a7b7bfe6-d6e1-4c17-ac2a-cc95af2ec3ed", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Mr. Smith stated that Mr. Chilukuri's representation \"got into one of Scott Gottlieb's public speeches yesterday, now people are asking how to do it, and it is clear he made it up entirely.\"", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:50+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49b-dbc73a24303a", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.78, "x": 0.11, "y": 0.71 }, "kind": "source-note", "text": "113-119 Footnotes detailing document references and source citations.", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:39.47+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ae2631a7-85de-4441-aac4-a8621a65d448", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.4, "x": 0.11, "y": 0.6 }, "kind": "title", "text": "iii. FDA / MITRE Subcontract (2016-2017)", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:39.47+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "47d0c015-3477-4d41-b325-db9957787c92", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } }, { "to": 40, "from": 24, "loop": { "name": "51_voice_of_customer", "slug": "51-voice-of-customer", "status": "active", "bestFor": "Product strategy, customer experience, market research", "canonId": "019dd956-7aaf-750b-950b-af0df38f5266", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "What Customers Say (Verbatim) -> The Pattern Across Voices -> The Insight -> The Response", "description": "Let customer quotes and feedback drive the narrative and validate the insight", "familyLabel": null }, "matchId": "308c22ef-34f3-45b8-b50d-c273c6edeb88", "evidence": "The document presents the concerns of regulatory bodies through examples of McKinsey's actions and lack of disclosure.", "position": 1, "objective": "What are the concerns of regulatory bodies regarding McKinsey's conflicts of interest?", "confidence": 0.6, "extraction": { "at": "2026-07-16 21:07:34.52569+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 26, "type": "setup", "title": "This slide is a text-heavy disclosure page from a report, likely a congressional or investigative document.", "function": "summarize", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "summarize", "functionCanon": { "name": "Summarize", "slug": "summarize", "status": "active", "canonId": "019de52d-1541-704f-b86f-bf7b75056373", "version": 1, "description": null }, "density": "dense", "densityScore": 74, "componentCount": 7, "textChars": 1873, "nDataPoints": 1, "notes": "This slide is a text-heavy disclosure page from a report, likely a congressional or investigative document.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:43.638+00", "seconds": 8.699, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/26", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-26", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "The MITRE subcontract's requirement that McKinsey identify and engage with “private sector” stakeholders “external to FDA” raises particular conflict of interest concerns, as McKinsey was actively consulting for some of the same private sector stakeholders at the time.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:50+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49c-1f763e83dc11", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.78, "x": 0.11, "y": 0.69 }, "kind": "disclaimer", "text": "120 MCK-HCOR-0174550 to MCK-HCOR-0174698 (McKinsey Purdue Engagement List); MCK-HCOR-0355686 to MCK-HCOR-0355698 (McKinsey FDA Engagement List). 121 MCK-HCOR-0355662, Pages 14-16. 122 MCK-HCOR-0174550 to MCK-HCOR-0174698 (McKinsey Purdue Engagement List). 123 Id. 124 MCK-HCOR-035567 4 to MCK-HCOR-0355680. 125 MCK-HCOR-0174550 to MCK-HCOR-0174698 (McKinsey Purdue Engagement List). 126 In September 2016, Mr. Smith took part in a meeting with the subject line “CALL with Arnie Ghatak and Jeff Smith re: Purdue.” MCK-HCOR-0177693. See also MCK-HCOR-0172519; MCK-HCOR-0177337; MCK-HCOR-0191809. In January 2017, Mr. Chilukuri was invited to a call titled “Big data/ real world evidence for abuse deterrence at Purdue Pharma.” MCK-HCOR-0326737.", "attrs": null, "canon": { "kind": { "name": "Disclaimer", "slug": "disclaimer", "status": "active", "canonId": "91173477-d91f-4024-bbaf-d4f93e3f82dc", "version": 1, "description": "Legal/cautionary text that occupies most of the body of its slide." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.638+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7dd767cf-96d1-4971-bb15-3a5510d4f92c", "parentComponentId": null }, { "bbox": { "h": 0.13, "w": 0.78, "x": 0.11, "y": 0.31 }, "kind": "paragraph", "text": "While McKinsey's subcontract with MITRE focused on addressing “clinical evidence gaps” for FDA trials, McKinsey had previously performed work on clinical trials for Purdue...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.638+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1bd59fec-9863-4ce4-9bb3-700267b6413a", "parentComponentId": null }, { "bbox": { "h": 0.13, "w": 0.78, "x": 0.11, "y": 0.16 }, "kind": "paragraph", "text": "The MITRE subcontract, valued at $1,199,405, required McKinsey to identify gaps in clinical evidence to improve regulatory decision-making...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.638+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1de32e22-0ac1-4945-8b39-95bfcc6e0670", "parentComponentId": null }, { "bbox": { "h": 0.07, "w": 0.78, "x": 0.11, "y": 0.45 }, "kind": "paragraph", "text": "The MITRE subcontract's requirement that McKinsey identify and engage with “private sector” stakeholders “external to FDA” raises particular conflict of interest concerns...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.638+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "783a2bf9-239e-407f-8ff5-62d334527313", "parentComponentId": null }, { "bbox": { "h": 0.07, "w": 0.78, "x": 0.11, "y": 0.54 }, "kind": "paragraph", "text": "McKinsey worked on at least five engagements at Purdue during its performance of the MITRE subcontract. While working on this subcontract, Mr. Smith and Mr. Chilukuri both took part in calls concerning Purdue’s opioid business...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.638+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c841cee8-2fac-4ad9-9128-68a1930ed5e9", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.78, "x": 0.11, "y": 0.11 }, "kind": "paragraph", "text": "MITRE subcontract, including Mr. Smith, Mr. Singh, and Mr. Chilukuri, were also working, or had previously worked, on projects related to Purdue.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.638+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "fc9a94bf-b165-4d96-a0d2-82ddbd7fbac0", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } }, { "to": 40, "from": 24, "loop": { "name": "51_voice_of_customer", "slug": "51-voice-of-customer", "status": "active", "bestFor": "Product strategy, customer experience, market research", "canonId": "019dd956-7aaf-750b-950b-af0df38f5266", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "What Customers Say (Verbatim) -> The Pattern Across Voices -> The Insight -> The Response", "description": "Let customer quotes and feedback drive the narrative and validate the insight", "familyLabel": null }, "matchId": "308c22ef-34f3-45b8-b50d-c273c6edeb88", "evidence": "The document presents the concerns of regulatory bodies through examples of McKinsey's actions and lack of disclosure.", "position": 1, "objective": "What are the concerns of regulatory bodies regarding McKinsey's conflicts of interest?", "confidence": 0.6, "extraction": { "at": "2026-07-16 21:07:34.52569+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 27, "type": "appendix", "title": "This appears to be a page from a formal report or legal document, containing narrative text and extensive footnotes.", "function": "appendix", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "appendix", "functionCanon": { "name": "Appendix", "slug": "appendix", "status": "active", "canonId": "019de52d-138d-750b-83c3-49b4bc7a7a38", "version": 1, "description": null }, "density": "dense", "densityScore": 53, "componentCount": 5, "textChars": 1018, "nDataPoints": 2, "notes": "This appears to be a page from a formal report or legal document, containing narrative text and extensive footnotes.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:38.893+00", "seconds": 3.307, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/27", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-27", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": { "h": 0.25, "w": 0.78, "x": 0.11, "y": 0.658 }, "kind": "disclaimer", "text": "127 MCK-HCOR-0355686 to MCK-HCOR-0355698 (McKinsey FDA Engagement List). 128 F.D.A. Nominee Deflects Criticism About Ties to Drugmakers at Hearing... 129 FDA Approves Drugs Faster Than Ever But Relies on Weaker Evidence... 130 MCK-HCOR-0351350, Page 6...", "attrs": null, "canon": { "kind": { "name": "Disclaimer", "slug": "disclaimer", "status": "active", "canonId": "91173477-d91f-4024-bbaf-d4f93e3f82dc", "version": 1, "description": "Legal/cautionary text that occupies most of the body of its slide." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:38.893+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e11cec8c-2d79-4e52-a47f-cf165140ed83", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.78, "x": 0.11, "y": 0.155 }, "kind": "paragraph", "text": "On November 16, 2017, McKinsey entered into a contract with FDA's Office of New Drugs to modernize CDER's New Drugs Regulatory Program, an award valued at $2,669,213.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:38.893+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2423a2cf-633f-46c5-b5d0-e0b6f2694454", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.78, "x": 0.11, "y": 0.411 }, "kind": "paragraph", "text": "Mr. Smith began serving as one of the lead McKinsey partners on the FDA New Drugs contract on December 6, 2017. The FDA contract listed him as the primary McKinsey consultant and Engagement Director. Just two days earlier, Mr. Smith had started another engagement at Purdue, called Project Scottsdale...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:38.893+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e8c409c4-6a80-44fe-b517-88a41856540b", "parentComponentId": null }, { "bbox": { "h": 0.11, "w": 0.78, "x": 0.11, "y": 0.273 }, "kind": "paragraph", "text": "FDA's Office of New Drugs oversees investigational studies during the drug development process and assesses the safety and effectiveness of new drugs. McKinsey's 2017 contract with FDA stated that the office needed “a strategic thought partner”...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:38.893+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f3875cde-7115-484e-848c-cc2e84fd2d0c", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.54, "x": 0.23, "y": 0.115 }, "kind": "title", "text": "iv. FDA Office of New Drugs Contract (2017-2018)", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:38.893+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "95e48a5d-6ad1-441b-b489-2628d781ffa0", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } }, { "to": 40, "from": 24, "loop": { "name": "51_voice_of_customer", "slug": "51-voice-of-customer", "status": "active", "bestFor": "Product strategy, customer experience, market research", "canonId": "019dd956-7aaf-750b-950b-af0df38f5266", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "What Customers Say (Verbatim) -> The Pattern Across Voices -> The Insight -> The Response", "description": "Let customer quotes and feedback drive the narrative and validate the insight", "familyLabel": null }, "matchId": "308c22ef-34f3-45b8-b50d-c273c6edeb88", "evidence": "The document presents the concerns of regulatory bodies through examples of McKinsey's actions and lack of disclosure.", "position": 1, "objective": "What are the concerns of regulatory bodies regarding McKinsey's conflicts of interest?", "confidence": 0.6, "extraction": { "at": "2026-07-16 21:07:34.52569+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 28, "type": "appendix", "title": "This appears to be a page from a formal report or legal document, likely an appendix or supporting evidence section.", "function": "appendix", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "appendix", "functionCanon": { "name": "Appendix", "slug": "appendix", "status": "active", "canonId": "019de52d-138d-750b-83c3-49b4bc7a7a38", "version": 1, "description": null }, "density": "dense", "densityScore": 62, "componentCount": 6, "textChars": 2034, "nDataPoints": 0, "notes": "This appears to be a page from a formal report or legal document, likely an appendix or supporting evidence section.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:43.171+00", "seconds": 7.478, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/28", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-28", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "While McKinsey was working on the contract for FDA's Office of New Drugs, McKinsey was also advising Purdue on issues related to new drugs that would be submitted for approval to the same office.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:50+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49c-306b826b24a4", "parentComponentId": null }, { "bbox": { "h": 0.085, "w": 0.764, "x": 0.118, "y": 0.478 }, "kind": "paragraph", "text": "In March 2018, while Mr. Smith was simultaneously working for both the FDA Office of New Drugs and Purdue, the Purdue announced that it expected to file its new drug application for Lemborexant. On May 21, 2018, Mr. Smith sent an email to Arnab Ghatak referring to a conversation with Purdue’s Vice President of Business Operations, stating that the Purdue official had told him: “Pipeline—generally more positive than they were a few months ago,” and", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.171+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9581b867-f103-46ee-8094-b915d963f446", "parentComponentId": null }, { "bbox": { "h": 0.075, "w": 0.764, "x": 0.118, "y": 0.178 }, "kind": "paragraph", "text": "Mr. Smith worked closely with Purdue management on Project Scottsdale, including attending dinners with senior officials. In an email to colleagues on December 22, 2017, one McKinsey consultant noted that Purdue’s chief of staff, a former McKinsey consultant himself, “invited us (Jeff, Abhi, team) to a dinner at his home, and we had a very nice evening.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.171+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b2a8f971-2844-44b9-9834-b39f51eef8d7", "parentComponentId": null }, { "bbox": { "h": 0.185, "w": 0.764, "x": 0.118, "y": 0.273 }, "kind": "paragraph", "text": "While McKinsey was working on the contract for FDA’s Office of New Drugs, McKinsey was also advising Purdue on issues related to new drugs that would be submitted for approval to the same office. As part of Project Scottsdale and Purdue’s reorganization, McKinsey reviewed the company’s pipeline of new drugs. The most valuable of these drugs would be placed in a company called “NewCo,” which would be “built to purpose to source, develop and commercialize a future, non-opioid portfolio.” Purdue believed that Lemborexant, an insomnia drug, held promise. McKinsey produced slides for Project Scottsdale that detailed the status of Lemborexant as well as the budget for the drug. Another presentation, produced in February 2018 by a hedge fund working with McKinsey on Purdue’s reorganization, stated: “Positive head-to-head data for Lemborexant justify further resource allocation.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.171+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ebd6d5ba-5643-4c0a-8535-dc7de2263e5c", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Pipeline—generally more positive than they were a few months ago,", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:50+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49c-3712b67d591b", "parentComponentId": null }, { "bbox": { "h": 0.33, "w": 0.764, "x": 0.118, "y": 0.595 }, "kind": "source-note", "text": "133-140: Detailed citations and references to internal documents and news articles.", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.171+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "831b451d-4275-4d85-ba89-d84707f6c9ce", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 28, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 6, "name": "Evidence & Proof", "beatId": "ca9c3ab4-903c-4ff0-b53d-42335d2ce596", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Evidence & Proof", "slug": "consultants-gambit-evidence-proof", "status": "active", "canonId": "019dd9b8-07b1-7688-8e1e-7637fec3802a", "version": 1, "description": null }, "evidence": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details.", "position": 1, "isPrimaryArc": true, "parentBeatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } }, { "to": 40, "from": 24, "loop": { "name": "51_voice_of_customer", "slug": "51-voice-of-customer", "status": "active", "bestFor": "Product strategy, customer experience, market research", "canonId": "019dd956-7aaf-750b-950b-af0df38f5266", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "What Customers Say (Verbatim) -> The Pattern Across Voices -> The Insight -> The Response", "description": "Let customer quotes and feedback drive the narrative and validate the insight", "familyLabel": null }, "matchId": "308c22ef-34f3-45b8-b50d-c273c6edeb88", "evidence": "The document presents the concerns of regulatory bodies through examples of McKinsey's actions and lack of disclosure.", "position": 1, "objective": "What are the concerns of regulatory bodies regarding McKinsey's conflicts of interest?", "confidence": 0.6, "extraction": { "at": "2026-07-16 21:07:34.52569+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 29, "type": "setup", "title": "This appears to be a page from a formal investigative report or committee document, given the footnote citations.", "function": "other", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "other", "functionCanon": { "name": "Other (fallback)", "slug": "other", "status": "active", "canonId": "019de52d-15e1-75bc-99dc-07732380e2ce", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 77, "componentCount": 8, "textChars": 2130, "nDataPoints": 0, "notes": "This appears to be a page from a formal investigative report or committee document, given the footnote citations.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:40.418+00", "seconds": 4.291, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/29", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-29", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "The Committee has uncovered several instances in which McKinsey consultants appear to have received information from FDA related to the agency’s regulation of opioids, which the consultants then shared with McKinsey colleagues working for private sector opioid clients.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:50+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49c-855eab7832b4", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.7, "x": 0.15, "y": 0.81 }, "kind": "disclaimer", "text": "141 MCK-HCOR-0141703. 142 MCK-HCOR-0035338, Slide 11. 143 As discussed above, McKinsey consultants circulated material that appeared to have been drawn from the FDA Sentinel Initiative with colleagues working for Purdue. MCK-HCOR-0330664. 144 MCK-HCOR-0341883 (emphasis added). 145 Id.", "attrs": null, "canon": { "kind": { "name": "Disclaimer", "slug": "disclaimer", "status": "active", "canonId": "91173477-d91f-4024-bbaf-d4f93e3f82dc", "version": 1, "description": "Legal/cautionary text that occupies most of the body of its slide." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.418+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f5e49275-0170-4b4b-8eda-04d556b8d697", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.7, "x": 0.15, "y": 0.65 }, "kind": "paragraph", "text": "On the same day, Rachel Sherman, then-Principal Deputy Director of FDA, sent a second document to FDA officials, including then-CDER Director Janet Woodcock, with notes about Commissioner Gottlieb’s input on the proposal document: “Scott will up the estimates from 500M to 650M. He would like a second version that gets us to 1B by COB tomorrow (in other words to expand the list).”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.418+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5bc03766-6be6-4742-802d-5d31133c1fc1", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.7, "x": 0.15, "y": 0.54 }, "kind": "paragraph", "text": "On January 23, 2018, an FDA official emailed then-FDA Commissioner Gottlieb and other senior officials a document entitled “Proposals for Consideration.” It is not clear what the proposals were, but later correspondence suggests that they involved spending priorities related to opioids and may have included federal initiatives connected to prescribing behavior that could have impacted McKinsey’s opioid clients.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.418+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6b769c7e-050a-468c-85b6-e002d79d738a", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.7, "x": 0.15, "y": 0.38 }, "kind": "paragraph", "text": "The Committee has uncovered several instances in which McKinsey consultants appear to have received information from FDA related to the agency’s regulation of opioids, which the consultants then shared with McKinsey colleagues working for private sector opioid clients.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.418+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b95e35e7-d08c-446a-b579-c787a55f085f", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.7, "x": 0.15, "y": 0.47 }, "kind": "paragraph", "text": "In one instance, a McKinsey consultant shared an FDA document concerning the opioid epidemic with another McKinsey consultant who at the time was working on a Purdue contract, though the precise nature of the document is not clear.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.418+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e97a7539-fed9-4553-b186-fb46cad7c9a4", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.7, "x": 0.15, "y": 0.74 }, "kind": "paragraph", "text": "After sending this email, Ms. Sherman sent the document to McKinsey Senior Partner Navjot Singh, writing: “Doc 2. Thanks! PS Please keep this to you (feel free to include Jeff,", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.418+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "eedf4524-410f-4f43-bd01-34060d2c9b7d", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.7, "x": 0.15, "y": 0.31 }, "kind": "title", "text": "4. McKinsey Consultants Shared FDA Information with Other Consultants Working for Private Sector Clients", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.418+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7516a2ba-9c0a-4e5e-bcfc-c61ff4ae9581", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } }, { "to": 40, "from": 24, "loop": { "name": "51_voice_of_customer", "slug": "51-voice-of-customer", "status": "active", "bestFor": "Product strategy, customer experience, market research", "canonId": "019dd956-7aaf-750b-950b-af0df38f5266", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "What Customers Say (Verbatim) -> The Pattern Across Voices -> The Insight -> The Response", "description": "Let customer quotes and feedback drive the narrative and validate the insight", "familyLabel": null }, "matchId": "308c22ef-34f3-45b8-b50d-c273c6edeb88", "evidence": "The document presents the concerns of regulatory bodies through examples of McKinsey's actions and lack of disclosure.", "position": 1, "objective": "What are the concerns of regulatory bodies regarding McKinsey's conflicts of interest?", "confidence": 0.6, "extraction": { "at": "2026-07-16 21:07:34.52569+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 30, "type": "setup", "title": "This appears to be a page from a formal investigative report or legal document, containing narrative text and footnotes.", "function": "summarize", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "summarize", "functionCanon": { "name": "Summarize", "slug": "summarize", "status": "active", "canonId": "019de52d-1541-704f-b86f-bf7b75056373", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 86, "componentCount": 10, "textChars": 2890, "nDataPoints": 0, "notes": "This appears to be a page from a formal investigative report or legal document, containing narrative text and footnotes.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:41.037+00", "seconds": 4.761, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/30", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-30", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "Documents show that McKinsey routinely highlighted its federal government relationships in an apparent effort to obtain private sector contracts.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:50+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49c-4f23b2ff4d30", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.7, "x": 0.15, "y": 0.275 }, "kind": "paragraph", "text": "Mr. Sarraf responded: \"Wow !!! gibberish ... a few that will actually lead to anything as best as I can see ... Appropriate opioid prescribing ... whatever. As if we dont know already and thats teh [sic] problem ... .\" It is unclear whether Mr. Sarraf shared the document further.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.037+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1d61b598-4a61-4674-a498-461a5594b842", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.7, "x": 0.15, "y": 0.185 }, "kind": "paragraph", "text": "Roughly a week later, on February 2, 2018, despite Ms. Sherman's request to limit distribution of the document, Mr. Smith forwarded the document to Pasha Saraff, a key McKinsey consultant working for Purdue. Mr. Smith stated: \"This is the list of projects that I referenced yesterday with Peter. I got Rachel to insert the last bucket on the list.\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.037+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7ec886a3-144e-46db-aae1-13da2c4c34eb", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.7, "x": 0.15, "y": 0.115 }, "kind": "paragraph", "text": "Sastry and Brandon if that would be helpful. Mr. Singh forwarded the document to a group of McKinsey consultants, including Mr. Smith, who was at the time working on contracts for both FDA and Purdue.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.037+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a670494d-66b0-4c16-af7f-815d5406d83b", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.7, "x": 0.15, "y": 0.375 }, "kind": "paragraph", "text": "Documents obtained by the Committee show that McKinsey consultants repeatedly utilized their government contacts and experience to showcase the firm's value to opioid manufacturers and solicit private sector business. These representations raise questions about whether McKinsey viewed its federal government contracts as means to gain more lucrative private sector business and whether sharing such information was an abuse of client confidences.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.037+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a919969e-a107-43e5-b100-9c41f0114108", "parentComponentId": null }, { "bbox": { "h": 0.2, "w": 0.7, "x": 0.15, "y": 0.48 }, "kind": "paragraph", "text": "For instance, McKinsey has internal policies to limit distribution of client information. According to McKinsey's “Use of Name” policy, the “names of our clients, the topics on which we serve them, and the advice we provide, should generally remain confidential.” Although McKinsey allows for disclosure of client work “with prior approval,” the policy provides that such disclosure may only be made “where this reflects a balance of benefits and risks, and the context of the sectors, geographies and client capabilities involved.” Similarly, McKinsey’s “Serving Competitors Policy” recognizes that conflicts occur across the public and private sectors and holds that maintaining “client confidences is among our most important professional responsibilities” and “the DCS [Director of Client Services] is responsible for ensuring that no confidential client information is disclosed outside of the CST [Client Service Team].”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.037+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ae90fda7-b224-4c77-943c-f78f9f5882af", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.7, "x": 0.15, "y": 0.67 }, "kind": "paragraph", "text": "Documents show that McKinsey routinely highlighted its federal government relationships in an apparent effort to obtain private sector contracts.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.037+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "efb7b547-b878-466e-a23d-80f7a200f77d", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Wow !!! gibberish ... a few that will actually lead to anything as best as I can see ... Appropriate opioid prescribing ... whatever. As if we dont know already and thats teh [sic] problem ... — Mr. Sarraf", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:50+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49c-50cbe48f1978", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.3, "x": 0.15, "y": 0.8 }, "kind": "source-note", "text": "146 Id. (emphasis added). 147 Id. (emphasis added). 148 Id. 149 MCK-HCOR-0352128, Page 2. 150 MCK-HCOR-0352196, Page 2.", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.037+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a6b1bb3a-e4c0-4526-9598-452fa8e82de6", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.7, "x": 0.15, "y": 0.345 }, "kind": "title", "text": "B. McKinsey Utilized Government Contracts to Secure Private Sector Business", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.037+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "656fb0cf-e572-4a0c-a034-31ae52763261", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } }, { "to": 40, "from": 24, "loop": { "name": "51_voice_of_customer", "slug": "51-voice-of-customer", "status": "active", "bestFor": "Product strategy, customer experience, market research", "canonId": "019dd956-7aaf-750b-950b-af0df38f5266", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "What Customers Say (Verbatim) -> The Pattern Across Voices -> The Insight -> The Response", "description": "Let customer quotes and feedback drive the narrative and validate the insight", "familyLabel": null }, "matchId": "308c22ef-34f3-45b8-b50d-c273c6edeb88", "evidence": "The document presents the concerns of regulatory bodies through examples of McKinsey's actions and lack of disclosure.", "position": 1, "objective": "What are the concerns of regulatory bodies regarding McKinsey's conflicts of interest?", "confidence": 0.6, "extraction": { "at": "2026-07-16 21:07:34.52569+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 31, "type": "evidence", "title": "The slide includes an excerpt from an email sent by McKinsey partners to a client, highlighting their strategy to win business.", "function": "illustrate_case", "rawType": "case_study", "block": null, "metadata": { "slideType": "case_study", "slideTypeCanon": { "name": "Case study", "slug": "case_study", "status": "active", "canonId": "019de52d-0b95-7344-8090-926f3b8e92c8", "version": 1, "description": null }, "function": "illustrate_case", "functionCanon": { "name": "Illustrate case", "slug": "illustrate_case", "status": "active", "canonId": "019de52d-13b4-772c-bb73-1873612a7463", "version": 1, "description": null }, "density": "dense", "densityScore": 60, "componentCount": 6, "textChars": 940, "nDataPoints": 1, "notes": "The slide includes an excerpt from an email sent by McKinsey partners to a client, highlighting their strategy to win business.", "elementsJson": [ "headline_text", "paragraph", "screenshot", "callout_box", "footnote" ], "confidence": 0.95, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:40.137+00", "seconds": 3.438, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/31", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-31", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "We believe McKinsey brings an unequaled capability based on who we know and what we know.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:50+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49c-68efbff584eb", "parentComponentId": null }, { "bbox": { "h": 0.28, "w": 0.7, "x": 0.15, "y": 0.45 }, "kind": "image", "text": "Email excerpt from McKinsey partners to Mark Timney", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Screenshot", "slug": "screenshot", "status": "active", "canonId": "019de52c-fd87-7509-8391-3d79fb339379", "version": 1, "description": null }, "framework": null }, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.137+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "346a5ad0-adc3-4663-bee2-90cdd6f6ec52", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.7, "x": 0.15, "y": 0.15 }, "kind": "paragraph", "text": "McKinsey appears to have touted its FDA experience directly to Purdue’s CEO in order to obtain additional consulting business. In 2014, Purdue hired Mark Timney as its new CEO. On January 23, 2014, after a breakfast meeting with Mr. Timney, McKinsey partners Rob Rosiello and Arnab Ghatak sent a follow-up email to Mr. Timney emphasizing key points from their meeting, including how McKinsey's public sector connections could benefit Purdue:", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.137+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "352825eb-cc54-42bd-84ba-b4ab4e26a4e7", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.7, "x": 0.15, "y": 0.79 }, "kind": "paragraph", "text": "At the time this email was sent, McKinsey was pitching Purdue on an $800,000 project to support Purdue’s efforts before an FDA Advisory Committee reviewing Targiniq, an opioid that Purdue had been developing for several years. McKinsey consultants, including Mr. Smith, had", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.137+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "35a8fef7-4957-47c0-ab41-6063eda51577", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.2, "x": 0.15, "y": 0.89 }, "kind": "source-note", "text": "151 MCK-HCOR-0099021.", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.137+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "02bbcbc8-d5d3-4db0-b742-91be97d7bf3f", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.7, "x": 0.15, "y": 0.11 }, "kind": "title", "text": "1. McKinsey Used FDA Experience to Win Business from Purdue’s CEO", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.137+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "923e64da-4c4b-43a3-bb44-4f3790a04c53", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } }, { "to": 40, "from": 24, "loop": { "name": "51_voice_of_customer", "slug": "51-voice-of-customer", "status": "active", "bestFor": "Product strategy, customer experience, market research", "canonId": "019dd956-7aaf-750b-950b-af0df38f5266", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "What Customers Say (Verbatim) -> The Pattern Across Voices -> The Insight -> The Response", "description": "Let customer quotes and feedback drive the narrative and validate the insight", "familyLabel": null }, "matchId": "308c22ef-34f3-45b8-b50d-c273c6edeb88", "evidence": "The document presents the concerns of regulatory bodies through examples of McKinsey's actions and lack of disclosure.", "position": 1, "objective": "What are the concerns of regulatory bodies regarding McKinsey's conflicts of interest?", "confidence": 0.6, "extraction": { "at": "2026-07-16 21:07:34.52569+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 32, "type": "setup", "title": "This page appears to be from a legal or investigative report, containing numbered footnotes referencing internal documents.", "function": "summarize", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "summarize", "functionCanon": { "name": "Summarize", "slug": "summarize", "status": "active", "canonId": "019de52d-1541-704f-b86f-bf7b75056373", "version": 1, "description": null }, "density": "dense", "densityScore": 63, "componentCount": 6, "textChars": 2881, "nDataPoints": 0, "notes": "This page appears to be from a legal or investigative report, containing numbered footnotes referencing internal documents.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:48.405+00", "seconds": 11.498, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/32", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-32", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "In March 2018, Mr. Elling explained in an email how he had “been successfully managing the CEO transitions at [redacted] Purdue.”", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:51+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49d-02d4d0441379", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.7, "x": 0.15, "y": 0.62 }, "kind": "paragraph", "text": "A draft McKinsey presentation from May 2009 appears to make McKinsey’s case for leading an Industry Working Group of two-dozen opioid manufacturers to develop class-wide FDA REMS. One slide asserted McKinsey’s “distinctive capabilities to support you in this effort” and listed among the firm’s qualifications, “Extensive experience serving Regulatory in industry and government.” The slide noted that McKinsey had “Supported regulatory bodies", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:48.405+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "563f4f28-992a-4601-b120-d678ca0103f1", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.7, "x": 0.15, "y": 0.11 }, "kind": "paragraph", "text": "forwarded Mr. Rosiello and Mr. Ghatak details of McKinsey’s proposal on January 22, 2014, the day before the above email to Purdue’s CEO.152 Six days later, on January 29, 2014, a McKinsey consultant wrote a group including Mr. Ghatak that “our Purdue CST [Client Service Team] has recently confirmed a number of really important engagements.”153 On January 30, 2014, McKinsey began the engagement preparing Purdue for the FDA Advisory Committee on Targiniq. McKinsey partner Jeff Smith co-led that FDA-facing effort.154 In addition, Mr. Ghatak and other McKinsey consultants at Purdue appear to have influenced Purdue’s CEO transitions. In March 2013, Mr. Elling emailed Mr. Ghatak and other McKinsey consultants stating, “Confidentially there is a search on for a new CEO at Purdue” and that they had been approached by “colleagues who are helping prep candidates.” Mr. Elling asked Mr. Ghatak and others to begin to prepare documents for “our colleagues” to help them “do a first pass at providing a profile of the company (in-line and pipeline).” He added, “it goes without saying that we should not be speaking of this to any colleagues.” Mr. Elling also stated that “when the time is right we may have a chance to brief some of the final canidates [sic].”155 Later that year, in August 2013, another McKinsey partner told Mr. Ghatak that he had given a Purdue executive “feedback on ceo candidates...do think we now have good access and dialogue with him.”156 In January 2014, Purdue announced Mr. Timney’s hiring as President and CEO.157 In March 2018, Mr. Elling explained in an email how he had “been successfully managing the CEO transitions at [redacted] Purdue.”158", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:48.405+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5a91bab5-6b59-4397-b6fe-9f6f7a26bc69", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“Confidentiality there is a search on for a new CEO at Purdue” — Mr. Elling", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:51+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49d-06ca9a212f22", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.7, "x": 0.15, "y": 0.75 }, "kind": "source-note", "text": "152 MCK-HCOR-0231695. 153 MCK-HCOR-0197410. 154 MCK-HCOR-0174550 to MCK-HCOR-0174698 (McKinsey Purdue Engagement List). 155 MCK-HCOR-0100789. 156 MCK-HCOR-0097967. 157 Purdue Pharma L.P. Names Mark Timney President and Chief Executive Officer, Biospace (Jan. 27, 2014) (online at www.biospace.com/article/releases/purdue-pharma-l-p-names-b-mark-timney-b-president-and-chief-executive-officer-/). 158 MCK-HCOR-0173821.", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:48.405+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5b03b491-c3a7-4b43-8d41-4831c3ba2907", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.7, "x": 0.15, "y": 0.56 }, "kind": "title", "text": "2. McKinsey Highlighted Its “Insights into the Perspectives of Regulators” in Attempt to Win Lead Role in Opioid Manufacturer Industry Group", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:48.405+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "93e631d6-b326-4f74-a587-20d55b073682", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } }, { "to": 40, "from": 24, "loop": { "name": "51_voice_of_customer", "slug": "51-voice-of-customer", "status": "active", "bestFor": "Product strategy, customer experience, market research", "canonId": "019dd956-7aaf-750b-950b-af0df38f5266", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "What Customers Say (Verbatim) -> The Pattern Across Voices -> The Insight -> The Response", "description": "Let customer quotes and feedback drive the narrative and validate the insight", "familyLabel": null }, "matchId": "308c22ef-34f3-45b8-b50d-c273c6edeb88", "evidence": "The document presents the concerns of regulatory bodies through examples of McKinsey's actions and lack of disclosure.", "position": 1, "objective": "What are the concerns of regulatory bodies regarding McKinsey's conflicts of interest?", "confidence": 0.6, "extraction": { "at": "2026-07-16 21:07:34.52569+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 33, "type": "setup", "title": "The slide is embedded within a larger document; the red oval is an annotation from the document author, not the original slide.", "function": "present_solution", "rawType": "client_example", "block": null, "metadata": { "slideType": "client_example", "slideTypeCanon": { "name": "Client example", "slug": "client_example", "status": "active", "canonId": "019de52d-0c87-77cb-9867-613ae22e95ac", "version": 1, "description": null }, "function": "present_solution", "functionCanon": { "name": "Present solution", "slug": "present_solution", "status": "active", "canonId": "019de52d-15b8-71da-bd23-2b767850cbce", "version": 1, "description": null }, "density": "balanced", "densityScore": 30, "componentCount": 4, "textChars": 501, "nDataPoints": 0, "notes": "The slide is embedded within a larger document; the red oval is an annotation from the document author, not the original slide.", "elementsJson": [ "paragraph", "comparison_table", "footnote" ], "confidence": 0.9, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:39.101+00", "seconds": 2.083, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/33", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-33", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "Developed distinctive expertise in Regulatory issues through supporting major pharmacos in redesigning their Regulatory functions.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:51+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49c-ba7661957177", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.6, "x": 0.2, "y": 0.29 }, "kind": "legend", "text": "Red oval highlighting the first row of the table.", "attrs": null, "canon": { "kind": { "name": "Legend", "slug": "legend", "status": "active", "canonId": "31361933-3d22-4c70-bbad-0801e9fffc0c", "version": 1, "description": "Color/symbol decoder placed adjacent to a chart or diagram." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:39.101+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2487f657-cc17-401f-9133-1a282934de8d", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.6, "x": 0.2, "y": 0.3 }, "kind": "table", "text": "Extensive experience serving Regulatory in industry and government; Proprietary Regulatory and Pain advisory boards; Deep expertise in pain management, including opioid space; Extensive experience managing long, highly complex projects", "attrs": null, "canon": { "kind": { "name": "Table", "slug": "table", "status": "active", "canonId": "019de52c-f9c8-7148-8119-eaac9594cd28", "version": 1, "description": "Tabular data layout." }, "tool": null, "subkind": { "name": "Data table", "slug": "data", "status": "active", "canonId": "019de52d-02d5-75b8-8abf-88e92bf63569", "version": 1, "description": null }, "framework": null }, "subkind": "data", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:39.101+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d39b76a5-9c7e-49c0-9bb3-11d3efaac929", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.6, "x": 0.2, "y": 0.24 }, "kind": "title", "text": "We believe McKinsey brings distinctive capabilities to support you in this effort (2/2)", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:39.101+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "93d4aefc-73a5-4c4d-ab4c-2d386346722a", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } }, { "to": 40, "from": 24, "loop": { "name": "51_voice_of_customer", "slug": "51-voice-of-customer", "status": "active", "bestFor": "Product strategy, customer experience, market research", "canonId": "019dd956-7aaf-750b-950b-af0df38f5266", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "What Customers Say (Verbatim) -> The Pattern Across Voices -> The Insight -> The Response", "description": "Let customer quotes and feedback drive the narrative and validate the insight", "familyLabel": null }, "matchId": "308c22ef-34f3-45b8-b50d-c273c6edeb88", "evidence": "The document presents the concerns of regulatory bodies through examples of McKinsey's actions and lack of disclosure.", "position": 1, "objective": "What are the concerns of regulatory bodies regarding McKinsey's conflicts of interest?", "confidence": 0.6, "extraction": { "at": "2026-07-16 21:07:34.52569+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 34, "type": "setup", "title": "This appears to be a page from a formal report or legal document, not a standard consulting deck slide.", "function": "summarize", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "summarize", "functionCanon": { "name": "Summarize", "slug": "summarize", "status": "active", "canonId": "019de52d-1541-704f-b86f-bf7b75056373", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 86, "componentCount": 10, "textChars": 2604, "nDataPoints": 0, "notes": "This appears to be a page from a formal report or legal document, not a standard consulting deck slide.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 0.9, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:46.238+00", "seconds": 9.082, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/34", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-34", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "McKinsey’s business relationships with opioid manufacturers appear to have posed significant organizational conflicts of interest for its consulting contracts with FDA—conflicts that are regulated and restricted by federal acquisition rules.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:51+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49c-d5afdb390fcb", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.5, "x": 0.15, "y": 0.35 }, "kind": "paragraph", "text": "C. McKinsey Failed to Disclose Serious Conflicts of Interest", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:46.238+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4bfddee4-2f56-4763-81e8-276ae3db4050", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.7, "x": 0.15, "y": 0.11 }, "kind": "paragraph", "text": "3. McKinsey Highlighted Its “Unique Relationships” with Centers for Medicare & Medicaid Services (CMS) Officials", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:46.238+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "59d87d21-1866-4028-bb8a-9e9e13391d57", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.7, "x": 0.15, "y": 0.17 }, "kind": "paragraph", "text": "McKinsey consultants also highlighted the firm’s connections with other federal agencies to opioid manufacturers. For instance, in November 2008, McKinsey submitted a project proposal to Purdue titled “Maximizing profits from Tramadol OD,” a type of opioid. In that presentation, McKinsey outlined the extent of its health care consulting business, implying that its connections with payors, hospitals, and government agencies could help achieve fuller reimbursement for Tramadol. On one slide, titled “Examples of who we serve,” McKinsey stated that it possesses “[u]nique relationships with CMS officials, industry associations and government-sponsored programs (e.g., NHS, TennCare, SingHealth),” referring to U.S. and foreign government health programs.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:46.238+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "78789da3-aba2-44df-be8c-10848b207b60", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.7, "x": 0.15, "y": 0.5 }, "kind": "paragraph", "text": "McKinsey does not appear to have disclosed any of these conflicts of interest to FDA.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:46.238+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c0110316-9978-4e72-9173-383067686617", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.7, "x": 0.15, "y": 0.39 }, "kind": "paragraph", "text": "McKinsey’s business relationships with opioid manufacturers appear to have posed significant organizational conflicts of interest for its consulting contracts with FDA—conflicts that are regulated and restricted by federal acquisition rules and the terms of many of McKinsey’s FDA contracts. McKinsey’s organizational conflicts of interest were likely exacerbated by its routine practice of staffing consultants at FDA and opioid manufacturers on projects with related subject matters.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:46.238+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c014104e-893c-422b-87e2-2f6bcf805505", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.7, "x": 0.15, "y": 0.54 }, "kind": "paragraph", "text": "1. Many of McKinsey’s FDA Contracts Required Disclosure of Potential Conflicts of Interest Pursuant to the Federal Acquisition Regulation", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:46.238+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c31e4776-068d-41ea-ba4b-830a25bc4be3", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.7, "x": 0.15, "y": 0.6 }, "kind": "paragraph", "text": "FDA procurement activities are governed by the Federal Acquisition Regulation (FAR), which includes rules for agencies to avoid, neutralize, and mitigate organizational conflicts of interests (OCI). The FAR states:", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:46.238+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c8431c41-a79c-4610-956e-8cfb1d312ea5", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.7, "x": 0.15, "y": 0.66 }, "kind": "quote", "text": "Organizational conflict of interest means that because of other activities or relationships with other persons, a person is unable or potentially unable to render impartial assistance or advice to the Government, or the person’s objectivity in performing the contract work is or might be otherwise impaired, or a person has an unfair competitive advantage.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Pull quote", "slug": "pull-quote", "status": "active", "canonId": "019de52c-fbf9-76fe-97e1-a0b7540445c9", "version": 1, "description": null }, "framework": null }, "subkind": "pull-quote", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:46.238+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "299a25d0-16ec-4412-9491-28a9bdf22d35", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.7, "x": 0.15, "y": 0.84 }, "kind": "source-note", "text": "162 MCK-HCOR-0037100, Slide 18. 163 See 48 C.F.R. §§ 9.5 et seq. (commonly cited as Federal Acquisition Regulation (FAR) Subpart 9.5). 164 48 C.F.R. § 2.101.", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:46.238+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "36fa55e9-d26f-4948-a957-8800bc912b3e", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } }, { "to": 40, "from": 24, "loop": { "name": "51_voice_of_customer", "slug": "51-voice-of-customer", "status": "active", "bestFor": "Product strategy, customer experience, market research", "canonId": "019dd956-7aaf-750b-950b-af0df38f5266", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "What Customers Say (Verbatim) -> The Pattern Across Voices -> The Insight -> The Response", "description": "Let customer quotes and feedback drive the narrative and validate the insight", "familyLabel": null }, "matchId": "308c22ef-34f3-45b8-b50d-c273c6edeb88", "evidence": "The document presents the concerns of regulatory bodies through examples of McKinsey's actions and lack of disclosure.", "position": 1, "objective": "What are the concerns of regulatory bodies regarding McKinsey's conflicts of interest?", "confidence": 0.6, "extraction": { "at": "2026-07-16 21:07:34.52569+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 35, "type": "setup", "title": "Page 35 of a larger document, containing extensive footnotes citing legal and journalistic sources.", "function": "summarize", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "summarize", "functionCanon": { "name": "Summarize", "slug": "summarize", "status": "active", "canonId": "019de52d-1541-704f-b86f-bf7b75056373", "version": 1, "description": null }, "density": "dense", "densityScore": 54, "componentCount": 5, "textChars": 1849, "nDataPoints": 0, "notes": "Page 35 of a larger document, containing extensive footnotes citing legal and journalistic sources.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:40.783+00", "seconds": 3.538, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/35", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-35", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": { "h": 0.12, "w": 0.78, "x": 0.11, "y": 0.38 }, "kind": "paragraph", "text": "Similar to other agencies, FDA “relies on the contractor to assess and report potential OCI and submit mitigation plans for review” before they are awarded a government contract. Agency officials rely on these disclosures “to ensure that they have the information they need to consider whether a contractor’s other business relationships risk slanting its judgment.” Some conflicts cannot be properly mitigated. In other instances, an agency may determine that a mitigation plan is appropriate to allow a contractor to “minimize the impact of prospective [conflicts] by establishing strategies to resolve anticipated conflicts,” for example, by firewalling conflicted individuals from certain information or tasks.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.783+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "376f4335-c264-4067-bc41-acb9f871ea27", "parentComponentId": null }, { "bbox": { "h": 0.07, "w": 0.78, "x": 0.11, "y": 0.18 }, "kind": "paragraph", "text": "Put plainly, a conflict of interest occurs when a contractor possesses, as the result of other business relationships, the incentive to provide biased advice under a government contract. The FAR thus protects government agencies from hiring contractors or advisors with “competing loyalties that could undermine the quality of their advice to the government.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.783+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "674d1ff3-bf97-49a4-b1b2-4840b42fd3f6", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.78, "x": 0.11, "y": 0.11 }, "kind": "paragraph", "text": "An “impaired objectivity” conflict of interest “arises where a firm’s ability to render impartial advice to the government would be undermined by the firm’s competing interests.” Government contractors, including consultants, must comply with these regulations.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.783+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7888a4aa-975f-45f5-8b0a-d25a85813397", "parentComponentId": null }, { "bbox": { "h": 0.09, "w": 0.78, "x": 0.11, "y": 0.27 }, "kind": "paragraph", "text": "In order to meet their duties under FAR Subpart 9.5 to “avoid, neutralize, or mitigate significant potential conflicts before contract award,” contracting officers rely on truthful disclosures from contractors. Federal agencies typically include language in their solicitations and contracts that highlight the duty to disclose potential OCIs, particularly in procurements for consultant or professional services where the risk of an OCI is greater.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.783+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d76fdb7c-000d-49fb-8be3-c8b3b96324f6", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.78, "x": 0.11, "y": 0.59 }, "kind": "source-note", "text": "Footnotes 165-171 detailing legal citations and source references.", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.783+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "64a698b5-81f1-427e-b093-547598edb040", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } }, { "to": 40, "from": 24, "loop": { "name": "51_voice_of_customer", "slug": "51-voice-of-customer", "status": "active", "bestFor": "Product strategy, customer experience, market research", "canonId": "019dd956-7aaf-750b-950b-af0df38f5266", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "What Customers Say (Verbatim) -> The Pattern Across Voices -> The Insight -> The Response", "description": "Let customer quotes and feedback drive the narrative and validate the insight", "familyLabel": null }, "matchId": "308c22ef-34f3-45b8-b50d-c273c6edeb88", "evidence": "The document presents the concerns of regulatory bodies through examples of McKinsey's actions and lack of disclosure.", "position": 1, "objective": "What are the concerns of regulatory bodies regarding McKinsey's conflicts of interest?", "confidence": 0.6, "extraction": { "at": "2026-07-16 21:07:34.52569+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 36, "type": "setup", "title": "This is a text-heavy page from a report or legal document, likely an appendix or supporting evidence page.", "function": "other", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "other", "functionCanon": { "name": "Other (fallback)", "slug": "other", "status": "active", "canonId": "019de52d-15e1-75bc-99dc-07732380e2ce", "version": 1, "description": null }, "density": "dense", "densityScore": 67, "componentCount": 7, "textChars": 1217, "nDataPoints": 0, "notes": "This is a text-heavy page from a report or legal document, likely an appendix or supporting evidence page.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:40.844+00", "seconds": 3.381, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/36", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-36", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "Making a false certification on a federal contract can lead to contract termination, suspension or debarment from future federal contracts, and civil or criminal penalties.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:51+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49c-ebe6a879a256", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.11, "y": 0.5 }, "kind": "paragraph", "text": "The False Claims Act (FCA) makes it illegal for contractors to “knowingly present, or cause to be presented, a false or fraudulent claim for payment or approval”...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.844+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "25748058-025d-4879-aac5-e3c38b9c68bd", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.11, "y": 0.41 }, "kind": "paragraph", "text": "Making a false certification on a federal contract can lead to contract termination, suspension or debarment from future federal contracts, and civil or criminal penalties.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.844+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "528960d1-f55e-4a64-a084-030bfd05e9d0", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.78, "x": 0.11, "y": 0.25 }, "kind": "paragraph", "text": "The Contractor warrants that, to the best of the Contractor’s knowledge and belief, there are no relevant facts or circumstances which would give rise to an organizational conflict of interest...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.844+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5c3e3f26-cee1-48af-adb2-9a638598082e", "parentComponentId": null }, { "bbox": { "h": 0.07, "w": 0.78, "x": 0.11, "y": 0.16 }, "kind": "paragraph", "text": "Many of McKinsey’s FDA contracts obtained by the Committee explicitly reference the FAR’s section governing OCIs, FAR Subpart 9.5, and put affirmative duties on McKinsey to disclose potential OCIs.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.844+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8c18536a-5d10-47ad-a9c5-df5a2948b816", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.78, "x": 0.11, "y": 0.11 }, "kind": "paragraph", "text": "The FAR warns that “organizational conflicts of interest are more likely to occur in contracts involving … [c]onsultant or other professional services.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.844+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d5f54553-5427-40fd-88fd-3da3b624d9e4", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.78, "x": 0.11, "y": 0.76 }, "kind": "source-note", "text": "172 48 C.F.R. § 9.502. 173 MCK-HCOR-0351504, Page 20. 174 Congressional Research Service... 175 Id.; 48 C.F.R. § 9.406-2. 176 31 U.S.C. § 3729(a)(1)(A)–(G) (2018)...", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:40.844+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "78b12511-eea1-4137-b6a2-d5db86fd779a", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } }, { "to": 40, "from": 24, "loop": { "name": "51_voice_of_customer", "slug": "51-voice-of-customer", "status": "active", "bestFor": "Product strategy, customer experience, market research", "canonId": "019dd956-7aaf-750b-950b-af0df38f5266", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "What Customers Say (Verbatim) -> The Pattern Across Voices -> The Insight -> The Response", "description": "Let customer quotes and feedback drive the narrative and validate the insight", "familyLabel": null }, "matchId": "308c22ef-34f3-45b8-b50d-c273c6edeb88", "evidence": "The document presents the concerns of regulatory bodies through examples of McKinsey's actions and lack of disclosure.", "position": 1, "objective": "What are the concerns of regulatory bodies regarding McKinsey's conflicts of interest?", "confidence": 0.6, "extraction": { "at": "2026-07-16 21:07:34.52569+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 37, "type": "appendix", "title": "This is a page from a legal or investigative report, containing footnotes and legal citations.", "function": "appendix", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "appendix", "functionCanon": { "name": "Appendix", "slug": "appendix", "status": "active", "canonId": "019de52d-138d-750b-83c3-49b4bc7a7a38", "version": 1, "description": null }, "density": "dense", "densityScore": 67, "componentCount": 6, "textChars": 2927, "nDataPoints": 1, "notes": "This is a page from a legal or investigative report, containing footnotes and legal citations.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:41.933+00", "seconds": 4.45, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/37", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-37", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "McKinsey's contracts for a federal regulator and a regulated entity could lead a reasonable person to question whether the firm's \"ability to render impartial advice to the government [was] undermined by the firm's competing interests.\"", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:51+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49d-369c82f376fb", "parentComponentId": null }, { "bbox": { "h": 0.105, "w": 0.764, "x": 0.118, "y": 0.568 }, "kind": "paragraph", "text": "McKinsey’s practice of staffing consultants on FDA projects who also consulted opioid manufacturers appeared to impair its objectivity. Some of the FDA and Purdue contracts on which McKinsey staffed consultants had seemingly conflicting aims. For instance, in 2009, McKinsey staffed a consultant on a project in which the firm recommended Purdue “defend against strict treatment by the FDA” in the agency’s opioid-REMS safety program or otherwise “Raise legal claims alleging FDA impropriety.” Yet in 2011, McKinsey staffed that same", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.933+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "20945752-37b0-4e42-8776-133f8180eeed", "parentComponentId": null }, { "bbox": { "h": 0.065, "w": 0.764, "x": 0.118, "y": 0.313 }, "kind": "paragraph", "text": "Despite the clear requirements in federal law, McKinsey appears to have repeatedly created serious, undisclosed conflicts of interest by consulting for both the FDA and opioid manufacturers, including on related matters and with overlapping staffing of consultants who shared information between clients.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.933+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "38e6195a-a38f-464a-a863-bb8b70bb32e2", "parentComponentId": null }, { "bbox": { "h": 0.165, "w": 0.764, "x": 0.118, "y": 0.378 }, "kind": "paragraph", "text": "As described above, McKinsey worked on several contracts at FDA regarding the safety and monitoring of dangerous drugs, including the 2011 contracts in the Office of Surveillance and Epidemiology and the three Sentinel Contracts from 2014 through 2018. During the same periods, McKinsey was working for or attempting to win additional business from Purdue to measure and compile findings about OxyContin’s safety for FDA’s review. McKinsey advised FDA on the structure and priorities of its surveillance offices and systems while simultaneously advising one of the nation’s largest opioid manufacturers how to demonstrate the safety of its opioids to FDA. McKinsey’s contracts for a federal regulator and a regulated entity could lead a reasonable person to question whether the firm’s “ability to render impartial advice to the government [was] undermined by the firm’s competing interests.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.933+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f0b29529-6e5b-4d36-87df-9c05026748de", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.764, "x": 0.118, "y": 0.72 }, "kind": "source-note", "text": "177 Department of Justice, The False Claims Act: A Primer (Apr. 22, 2011) (online at www.justice.gov/sites/default/files/civil/legacy/2011/04/22/C-FRAUDS_FCA_Primer.pdf). 178 Congressional Research Service, Selected Legal Tools for Maintaining Government Contractor Accountability (Sept. 26, 2018) (online at www.crs.gov/Reports/R45322); Federal Register, Civil Monetary Penalty Inflation Adjustment (Jan. 13, 2022) (online at www.federalregister.gov/documents/2022/01/13/2022-00506/civil-monetary-penalty-inflation-adjustment). 179 See 18 U.S.C. § 287. 180 See 48 C.F.R. §§ 9.505-3, 9.505(a); Aetna Gov’t Health Plans, Inc.; Foundation Health Fed. Servs., Inc., B-254397 et al., July 27, 1995, 95-2 CPD 129 at 13; Leidos, Inc., B-417994, Dec. 17, 2019, 2019 CPD ¶ 425. 181 MCK-HCOR-0340667, Slide 1; MCK-HCOR-0339718; MCK-HCOR-0225929.", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.933+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c2055b1e-97e7-4080-a765-d778df490828", "parentComponentId": null }, { "bbox": { "h": 0.045, "w": 0.764, "x": 0.118, "y": 0.238 }, "kind": "title", "text": "2. McKinsey Had Extensive Conflicts of Interest in Apparent Violation of the Federal Acquisition Regulation and Contract Terms", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.933+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d0a1f069-257b-4042-a62d-4d0d6c0fd174", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } }, { "to": 40, "from": 24, "loop": { "name": "51_voice_of_customer", "slug": "51-voice-of-customer", "status": "active", "bestFor": "Product strategy, customer experience, market research", "canonId": "019dd956-7aaf-750b-950b-af0df38f5266", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "What Customers Say (Verbatim) -> The Pattern Across Voices -> The Insight -> The Response", "description": "Let customer quotes and feedback drive the narrative and validate the insight", "familyLabel": null }, "matchId": "308c22ef-34f3-45b8-b50d-c273c6edeb88", "evidence": "The document presents the concerns of regulatory bodies through examples of McKinsey's actions and lack of disclosure.", "position": 1, "objective": "What are the concerns of regulatory bodies regarding McKinsey's conflicts of interest?", "confidence": 0.6, "extraction": { "at": "2026-07-16 21:07:34.52569+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 38, "type": "setup", "title": "This is a page from a formal investigative report, likely a Congressional committee report.", "function": "summarize", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "summarize", "functionCanon": { "name": "Summarize", "slug": "summarize", "status": "active", "canonId": "019de52d-1541-704f-b86f-bf7b75056373", "version": 1, "description": null }, "density": "dense", "densityScore": 69, "componentCount": 7, "textChars": 1616, "nDataPoints": 0, "notes": "This is a page from a formal investigative report, likely a Congressional committee report.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:44.48+00", "seconds": 6.695, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/38", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-38", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "Based on information and documents available to the Committee, it appears that McKinsey failed to disclose its private sector engagements that could reasonably be seen as impairing its objectivity in relation to its FDA contracts.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:51+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49d-1ec4250bfde1", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.11, "y": 0.55 }, "kind": "paragraph", "text": "Based on information and documents available to the Committee, it appears that McKinsey failed to disclose its private sector engagements that could reasonably be seen as impairing its objectivity in relation to its FDA contracts, in violation of FAR Subpart 9.5 and the related disclosure requirements of several contracts.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:44.48+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0520ea89-2318-4f8e-9588-bf8fa24969f9", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.78, "x": 0.11, "y": 0.43 }, "kind": "paragraph", "text": "In response to a ProPublica inquiry in 2021, FDA stated that it was unable to locate any files where McKinsey disclosed its conflicts of interest to FDA.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:44.48+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9ea20f1e-5d46-405f-b8f2-d649bafa98d5", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.78, "x": 0.11, "y": 0.31 }, "kind": "paragraph", "text": "Despite the extensive evidence of organizational conflicts of interest at McKinsey, FDA stated in response to a request from several Senators that it was “not aware of any disclosures made by McKinsey vis-a-vis OCI [organizational conflicts of interest] in relation to” the 10 contracts that included specific language on organizational conflicts. FDA further stated that it only became aware that McKinsey had taken on opioid manufacturers as clients “in early 2021 when the information was reported in the media.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:44.48+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a48ba226-d8be-42eb-a1d2-e803bc264c4c", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.78, "x": 0.11, "y": 0.485 }, "kind": "paragraph", "text": "On November 5, 2021, the Committee requested that McKinsey provide “All documents disclosing or referring to a conflict of interest with FDA since 2008.” McKinsey has not produced any documents responsive to that request.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:44.48+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c20a0b3a-cb32-4018-a47a-cb1444248403", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.78, "x": 0.11, "y": 0.705 }, "kind": "source-note", "text": "182-185: Citations for the claims made in the text, including letters from the FDA and the Committee on Oversight and Reform.", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:44.48+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a3fb0d43-7183-486c-97e8-402e0d14e65f", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.78, "x": 0.11, "y": 0.275 }, "kind": "title", "text": "3. No Evidence that McKinsey Disclosed Conflicts", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:44.48+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b43b3a96-4580-41c6-9bda-7e58dcba7931", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } }, { "to": 40, "from": 24, "loop": { "name": "51_voice_of_customer", "slug": "51-voice-of-customer", "status": "active", "bestFor": "Product strategy, customer experience, market research", "canonId": "019dd956-7aaf-750b-950b-af0df38f5266", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "What Customers Say (Verbatim) -> The Pattern Across Voices -> The Insight -> The Response", "description": "Let customer quotes and feedback drive the narrative and validate the insight", "familyLabel": null }, "matchId": "308c22ef-34f3-45b8-b50d-c273c6edeb88", "evidence": "The document presents the concerns of regulatory bodies through examples of McKinsey's actions and lack of disclosure.", "position": 1, "objective": "What are the concerns of regulatory bodies regarding McKinsey's conflicts of interest?", "confidence": 0.6, "extraction": { "at": "2026-07-16 21:07:34.52569+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 39, "type": "setup", "title": "This is a page from a formal report or legal document, likely a congressional or investigative committee report.", "function": "summarize", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "summarize", "functionCanon": { "name": "Summarize", "slug": "summarize", "status": "active", "canonId": "019de52d-1541-704f-b86f-bf7b75056373", "version": 1, "description": null }, "density": "dense", "densityScore": 63, "componentCount": 6, "textChars": 3621, "nDataPoints": 0, "notes": "This is a page from a formal report or legal document, likely a congressional or investigative committee report.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:42.394+00", "seconds": 4.597, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/39", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-39", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "McKinsey has not provided documents to the Committee showing that it adequately disclosed any relationship with a specific pharmaceutical company in line with this policy.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:52+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49d-cb34eb247569", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.7, "x": 0.15, "y": 0.33 }, "kind": "paragraph", "text": "McKinsey’s policy on conflicts of interest also states that it “will seek to minimize the scope of disclosures to what is absolutely necessary.” The policy provides that unless McKinsey can avoid a conflict through internal processes, “the potential conflict will be reported ... to the public sector client’s Contracting Officer with a mitigation proposal.” The policy recognizes that disclosure may result in the contracting office determining that McKinsey is “conflicted from serving on the public sector engagement, or as part of the contracting process may require McKinsey to perform further measures to mitigate any OCI.”188", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.394+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1b75cd2c-ada5-4d10-af02-e5feb320de7b", "parentComponentId": null }, { "bbox": { "h": 0.2, "w": 0.7, "x": 0.15, "y": 0.49 }, "kind": "paragraph", "text": "McKinsey has not provided documents to the Committee showing that it adequately disclosed any relationship with a specific pharmaceutical company in line with this policy. While McKinsey has stated that its “proposals to the FDA frequently mentioned the company’s and personnel’s experience with the pharmaceutical industry, making the FDA aware of this aspect of McKinsey’s work in the field,” McKinsey’s isolated and vague references to its private sector clients in the documents produced to the Committee did not lay out any information necessary to assess its conflicts with opioid manufacturers or convey its conflicts in the manner required by McKinsey’s firm policy, which states that the “potential conflict will be reported, as described below, to the public sector client’s Contracting Officer with a mitigation proposal.”189", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.394+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6e51d97e-3ea3-4804-ae80-aab61fac6209", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.7, "x": 0.15, "y": 0.17 }, "kind": "paragraph", "text": "McKinsey provided the Committee with a detailed “Organizational Conflicts of Interest Policy” for raising and assessing conflicts in relation to government contracts under federal regulations. The stated purpose of that policy is to “ensure compliance with U.S. Government organizational conflict of interest (“OCI”) requirements.”186 The policy states that McKinsey’s standard to determine whether a business interest presents “even the appearance of an OCI is whether the business interest in question would cause a reasonable person with knowledge of the relevant facts to question the impartiality of [McKinsey] in performing work under the solicitation or task order in question.”187", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.394+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ad0c8b6f-77f5-413c-90ff-ad31ed55bdb0", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.7, "x": 0.15, "y": 0.72 }, "kind": "source-note", "text": "186 MCK-HCOR-0352178, Page 1. 187 Id., Page 2. 188 Id., Pages 2 and 4. 189 Watchdog Urged to Probe McKinsey Over Work with FDA, Opioid Manufacturers, ABC News (Apr. 5, 2022) (online at https://abcnews.go.com/US/watchdog-urged-probe-mckinsey-work-fda-opioid-manufacturers/story?id=83869544); MCK-HCOR-0352178, Page 3. One of McKinsey’s technical proposals submitted to the FDA in 2019 contained a two-page biography for Mr. Smith, including a subsection explaining that Mr. Smith’s “Recent Relevant Experience” included leading a team “developing an abuse-deterrent technology for opioid analgesics” for a pharmaceutical company. MCK-HCOR-0341261, A-4. Mr. Smith’s biography does not list his numerous opioid-related engagements at Purdue over the past decade, does not disclose that he worked for FDA and Purdue simultaneously, and does not mention Purdue by name, despite the Massachusetts Attorney General filing a civil complaint against the company earlier that year and extensive reporting of that lawsuit. The project description also does not appear to match Mr. Smith’s experience at Purdue and potentially represents a description of his work for a different opioid company.", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.394+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f3f931ee-ede9-42f7-9f47-0052251bc154", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.7, "x": 0.15, "y": 0.11 }, "kind": "title", "text": "4. McKinsey Was Aware of Its Duties to Avoid and Disclose Conflicts of Interest Under Its Contracts and the FAR", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.394+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b6bcb80a-9aaf-48ed-9c40-0210bd51f3a3", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } }, { "to": 40, "from": 24, "loop": { "name": "51_voice_of_customer", "slug": "51-voice-of-customer", "status": "active", "bestFor": "Product strategy, customer experience, market research", "canonId": "019dd956-7aaf-750b-950b-af0df38f5266", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "What Customers Say (Verbatim) -> The Pattern Across Voices -> The Insight -> The Response", "description": "Let customer quotes and feedback drive the narrative and validate the insight", "familyLabel": null }, "matchId": "308c22ef-34f3-45b8-b50d-c273c6edeb88", "evidence": "The document presents the concerns of regulatory bodies through examples of McKinsey's actions and lack of disclosure.", "position": 1, "objective": "What are the concerns of regulatory bodies regarding McKinsey's conflicts of interest?", "confidence": 0.6, "extraction": { "at": "2026-07-16 21:07:34.52569+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 40, "type": "setup", "title": "This appears to be a page from a formal investigative report or legal document.", "function": "summarize", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "summarize", "functionCanon": { "name": "Summarize", "slug": "summarize", "status": "active", "canonId": "019de52d-1541-704f-b86f-bf7b75056373", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 77, "componentCount": 8, "textChars": 2035, "nDataPoints": 0, "notes": "This appears to be a page from a formal investigative report or legal document.", "elementsJson": [ "paragraph", "bullet_list", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:42.283+00", "seconds": 4.481, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/40", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-40", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "The Committee's investigation has uncovered evidence that McKinsey's Healthcare Systems and Services practice—a government and policy facing health care practice at McKinsey—sought input from members of its private sector pharmaceutical practice, who served Purdue and other opioid manufacturers.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:51+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49d-4dece38811ef", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.78, "x": 0.11, "y": 0.2 }, "kind": "list", "text": "Federal agencies, including the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention (CDC), and the Substance Abuse and Mental Health Services Administration; States and state agencies, including Virginia, Missouri, Massachusetts, New Hampshire, Delaware, Vermont, Ohio Medicaid, Ohio Corrections, and Alabama Medicaid; and Local governments, including New York City and elsewhere.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.283+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7b461a57-d2a4-46b6-8f7d-d289858da769", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.11, "y": 0.11 }, "kind": "paragraph", "text": "The extent to which McKinsey's management followed this guidance for its contracts with FDA is unclear. In addition, McKinsey's potential opioid-related conflicts of interest may extend to its work for numerous other federal and state government entities.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.283+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5b322b25-3acb-4da6-a2c5-f76d6b2c2e81", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.78, "x": 0.11, "y": 0.38 }, "kind": "paragraph", "text": "The McKinsey Organizational Conflicts of Interest Policy states that it may be used \"[w]here appropriate\" as \"guidance when responding to state and local procurements.\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.283+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6c9c74b2-b4b5-42d3-8aab-fdddb594a25b", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.11, "y": 0.59 }, "kind": "paragraph", "text": "The Committee's investigation has uncovered evidence that McKinsey's Healthcare Systems and Services practice—a government and policy facing health care practice at McKinsey—sought input from members of its private sector pharmaceutical practice, who served Purdue and other opioid manufacturers.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.283+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6fcc9b43-ae31-4edd-9808-7ada74fa4d2a", "parentComponentId": null }, { "bbox": { "h": 0.07, "w": 0.78, "x": 0.11, "y": 0.49 }, "kind": "paragraph", "text": "Documents obtained by the Committee suggest that McKinsey may have sought to use its influence with government clients to advocate for policy positions or selectively share information with government officials that benefited its private sector clients.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.283+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9f374d99-e941-4226-9608-46705c669c61", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.11, "y": 0.82 }, "kind": "source-note", "text": "190 MCK-HCOR-0127852. 191 MCK-HCOR-0352178, Page 1. 192 McKinsey & Company, Healthcare Systems & Services (online at www.mckinsey.com/industries/healthcare-systems-and-services/how-we-help-clients) (accessed Feb. 22, 2022).", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.283+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f097d4f3-e1ea-4910-8d4b-f391f22a8aa8", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.78, "x": 0.11, "y": 0.43 }, "kind": "title", "text": "D. McKinsey Consultants Working for Opioid Manufacturers Influenced Policy Documents McKinsey Submitted to Government Clients", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.283+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "701ff83d-5f17-4f32-86ec-8d9f1234dbc9", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } }, { "to": 40, "from": 24, "loop": { "name": "51_voice_of_customer", "slug": "51-voice-of-customer", "status": "active", "bestFor": "Product strategy, customer experience, market research", "canonId": "019dd956-7aaf-750b-950b-af0df38f5266", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "What Customers Say (Verbatim) -> The Pattern Across Voices -> The Insight -> The Response", "description": "Let customer quotes and feedback drive the narrative and validate the insight", "familyLabel": null }, "matchId": "308c22ef-34f3-45b8-b50d-c273c6edeb88", "evidence": "The document presents the concerns of regulatory bodies through examples of McKinsey's actions and lack of disclosure.", "position": 1, "objective": "What are the concerns of regulatory bodies regarding McKinsey's conflicts of interest?", "confidence": 0.6, "extraction": { "at": "2026-07-16 21:07:34.52569+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 41, "type": "evidence", "title": "This appears to be a page from a formal investigative report or legal document, containing footnotes and an email excerpt.", "function": "cite_precedent", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "cite_precedent", "functionCanon": { "name": "Cite precedent", "slug": "cite_precedent", "status": "active", "canonId": "019de52d-142b-714b-86d4-58aad7b568ec", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 75, "componentCount": 8, "textChars": 1364, "nDataPoints": 0, "notes": "This appears to be a page from a formal investigative report or legal document, containing footnotes and an email excerpt.", "elementsJson": [ "headline_text", "paragraph", "screenshot", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:41.584+00", "seconds": 3.474, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/41", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-41", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": { "h": 0.25, "w": 0.7, "x": 0.15, "y": 0.27 }, "kind": "other", "text": "From: Alex Azar [Redacted] To: Martin Elling [martin_elling@mckinsey.com] Date: 02/06/2017 09:33 AM Subject: Connecting on job search ... [Email body text]", "attrs": null, "canon": { "kind": { "name": "Other", "slug": "other", "status": "active", "canonId": "019de52c-fa90-743c-8bf6-20d1fbe82b6d", "version": 1, "description": "Fallback when no canonical kind applies." }, "tool": null, "subkind": { "name": "Unclassified", "slug": "unclassified", "status": "active", "canonId": "019de52d-05ca-77db-81fb-db7d4234bbc0", "version": 1, "description": null }, "framework": null }, "subkind": "unclassified", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.584+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4b216d13-edaa-4c9b-8036-b1dafe369400", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.7, "x": 0.15, "y": 0.64 }, "kind": "paragraph", "text": "On November 13, 2017, then-President Trump nominated Alex Azar to be the Secretary of Health and Human Services. On January 24, 2018, the Senate confirmed his nomination.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.584+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0ff57e18-fa1a-4c27-bc70-aa0ce1fea666", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.7, "x": 0.15, "y": 0.57 }, "kind": "paragraph", "text": "A meeting invitation obtained by the Committee indicates that May 1, 2017, Mr. Elling and other McKinsey consultants hosted Mr. Azar at McKinsey’s New York office “RE: Connecting on job search.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.584+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "31981b03-eac0-412d-9dbc-2c4acdf2f0b7", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.7, "x": 0.15, "y": 0.69 }, "kind": "paragraph", "text": "According to documents obtained by the Committee, shortly thereafter, McKinsey consultants privately sent Secretary Azar a six-page transition memo entitled, “Setting the course for the US Department of Health and Human Services.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.584+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "748caf25-17fd-408b-a03a-9345a10d54ec", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.7, "x": 0.15, "y": 0.18 }, "kind": "paragraph", "text": "In January 2017, Alex Azar left his position as President of pharmaceutical company Eli Lilly and Company. Shortly thereafter, he emailed McKinsey consultant Martin Elling, a lead consultant for Purdue, for help with his job search.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.584+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b6d65255-d062-4cac-89d5-5739955bbc50", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "I’d really value sitting with you guys and talking through ideas you may have and advice on how to look at and for opportunities.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:52+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49d-afbd6b5e77df", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.7, "x": 0.15, "y": 0.78 }, "kind": "source-note", "text": "193-196: Citations regarding Azar's severance, McKinsey documents, and Trump's nomination.", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.584+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8c804868-e5be-4b8b-8abf-7fec2bb5503c", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.7, "x": 0.15, "y": 0.11 }, "kind": "title", "text": "1. McKinsey Sent HHS Secretary Azar a Policy Memo Influenced by Consultants Working for Opioid Manufacturers and Had Previously Unknown Contacts with Secretary Azar", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:41.584+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ac8d54f6-a925-4b3b-9754-b0e5a2f141e3", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 42, "type": "setup", "title": "This appears to be a page from a formal investigative report or legal document, indicated by the footnote citations.", "function": "other", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "other", "functionCanon": { "name": "Other (fallback)", "slug": "other", "status": "active", "canonId": "019de52d-15e1-75bc-99dc-07732380e2ce", "version": 1, "description": null }, "density": "dense", "densityScore": 63, "componentCount": 6, "textChars": 2849, "nDataPoints": 0, "notes": "This appears to be a page from a formal investigative report or legal document, indicated by the footnote citations.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:46.036+00", "seconds": 7.73, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/42", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-42", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "Given the conflicts between the Industry and what the Secretary of HHS might want to do we should tread carefully eg I would be careful about people who serve Opioid Manufacturers.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:52+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49d-df924745f75e", "parentComponentId": null }, { "bbox": { "h": 0.22, "w": 0.78, "x": 0.11, "y": 0.57 }, "kind": "paragraph", "text": "The next morning, Senior Partner Navjot Singh wrote that given “conflicts between McKinsey should “tread carefully” with respect to the memo. He cautioned: Given the conflicts between the Industry and what the Secretary of HHS might want to do we should tread carefully eg I would be careful about people who serve Opioid Manufacturers (sorry Martin [Elling] and Arnie [Ghatak]) influencing the opioid section. Perfectly fine to share wisdom but maybe let people who are at a distance take the pen who maybe our HHS colleagues [sic].204 An additional response by Mr. Singh was redacted by McKinsey, but Mr. Singh added that he would be “[h]appy to discuss this live.”205", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:46.036+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "3d50a603-1590-4789-ab47-38a8af9ae60e", "parentComponentId": null }, { "bbox": { "h": 0.22, "w": 0.78, "x": 0.11, "y": 0.34 }, "kind": "paragraph", "text": "McKinsey began preparing the memo to Secretary Azar prior to his confirmation. On January 17, 2018, Stephanie Carlton, the partner who co-leads McKinsey’s Center for US Health System Reform, wrote to two senior McKinsey partners in the pharmaceutical practice, both of whom had previously served opioid manufacturers, noting that McKinsey was sending a transition memo to incoming Secretary Azar, and seeking their input.201 Ms. Carlton wrote that another McKinsey partner “is sending a transition memo to Alex Azar (as soon as the full Senate vote happens). The full memo is attached, but 2 sections in particular I wanted to flag for you: drug prices and opioids.”202 That evening, another McKinsey partner forwarded the memo to other McKinsey consultants serving opioid clients for their feedback.203", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:46.036+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "bc93074d-6417-4868-a1a4-acb13ff67384", "parentComponentId": null }, { "bbox": { "h": 0.22, "w": 0.78, "x": 0.11, "y": 0.11 }, "kind": "paragraph", "text": "consultants had prepared a similar memo for former President Trump's first HHS Secretary, Tom Price to address “several operational perspectives for HHS.”197 Based on internal McKinsey emails, the transition memo to Secretary Azar was reviewed or edited by consultants working for opioid manufacturers.198 McKinsey noted in the Secretary Azar memo that, “McKinsey is a non-partisan firm; we do not provide policy advice or recommendations. Accordingly, we provide only our perspectives on the potential ramifications of various policy options, including for the private sector.”199 However, the memo prepared for Secretary Azar contained “strategic priorities” that appear to be functionally identical to recommendations, and noted policy-oriented “actions” that HHS “might consider.”200", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:46.036+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f72b729d-33d6-4854-b9db-0139243d6088", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Given the conflicts between the Industry and what the Secretary of HHS might want to do we should tread carefully eg I would be careful about people who serve Opioid Manufacturers (sorry Martin [Elling] and Arnie [Ghatak]) influencing the opioid section. Perfectly fine to share wisdom but maybe let people who are at a distance take the pen who maybe our HHS colleagues [sic]. — Navjot Singh", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:52+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49d-e340b88fbd1d", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.35, "x": 0.11, "y": 0.81 }, "kind": "source-note", "text": "197-205 citations", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:46.036+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d0720140-5e55-4cc2-85ba-8e30d0294ca0", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 43, "type": "evidence", "title": "This slide appears to be from a report or legal document detailing McKinsey's involvement with Purdue Pharma, specifically focusing on the 'ADF Strategy'.", "function": "cite_precedent", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "cite_precedent", "functionCanon": { "name": "Cite precedent", "slug": "cite_precedent", "status": "active", "canonId": "019de52d-142b-714b-86d4-58aad7b568ec", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 87, "componentCount": 11, "textChars": 2670, "nDataPoints": 0, "notes": "This slide appears to be from a report or legal document detailing McKinsey's involvement with Purdue Pharma, specifically focusing on the 'ADF Strategy'.", "elementsJson": [ "paragraph", "callout_box", "footnote" ], "confidence": 0.9, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:43.016+00", "seconds": 4.64, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/43", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-43", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "One really powerful move could be to require that all opioids reimbursed by HHS must have abuse deterrent formulations.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:52+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49d-7436cc412f5f", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.11, "y": 0.11 }, "kind": "paragraph", "text": "Despite expressing a concern that McKinsey should “drive the debate with data and facts,” in a subsequent email and having previously participated on Purdue matters himself, Mr. Singh stated: “I am happy to take the pen and make some line edits to stress these areas.”206 It is unclear what line edits Mr. Singh made.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.016+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "3198a323-0c9f-4373-a3ca-2a46c990cc79", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.78, "x": 0.11, "y": 0.73 }, "kind": "paragraph", "text": "Specifically, since 2014, McKinsey and Mr. Ghatak had pushed what the firm referred to as the “ADF Strategy” at Purdue. Under McKinsey’s recommendation, Purdue would submit an", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.016+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "52bd451d-430c-456b-bf5e-aecef71642ab", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.11, "y": 0.33 }, "kind": "paragraph", "text": "Mr. Ghatak then suggested adding caveats in the memo that would shift focus away from opioid manufacturers, noting that the opioid crisis “is not purely about prescription drugs, a large part of it involves heroin.” Mr. Ghatak stated, “I think it is important to acknowledge that the opioid crisis is multi-factorial,” and he continued, “In fact, think we could suggest a big data approach to better understanding these issues so the root issues can be addressed.”208", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.016+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5e621843-8974-45bd-bcdc-566c92558fb1", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.78, "x": 0.11, "y": 0.28 }, "kind": "paragraph", "text": "In the internal email transmitting his feedback to his McKinsey colleagues, Mr. Ghatak stated, “First for disclosure, I serve a manufacturer of opioids.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.016+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6e1a46d0-7199-4237-94de-9ba6c0cc1e30", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.11, "y": 0.43 }, "kind": "paragraph", "text": "Mr. Ghatak also suggested edits shifting the blame for the crisis away from his client’s drug, OxyContin, and onto generic formulations, noting that “the vast volume of prescriptions (90%+) are actually generics and many of the branded ones now have abuse deterrent properties but the generics don’t.” Mr. Ghatak proposed: “One really powerful move could be to require that all opioids reimbursed by HHS must have abuse deterrent formulations.”209", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.016+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a462270a-3db1-410a-bc6f-d5e9aa275685", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.78, "x": 0.11, "y": 0.2 }, "kind": "paragraph", "text": "Despite Mr. Singh’s warning, the following day Mr. Ghatak, who had led more than 30 engagements at Purdue and was working on a Purdue contract at this time, provided extensive feedback on the Azar memo that would appear to strongly benefit his clients in the opioid industry.207", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.016+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c1041311-0fa3-43f6-ac5b-9d67460f2b00", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.78, "x": 0.11, "y": 0.67 }, "kind": "paragraph", "text": "Mr. Ghatak’s recommendation to convert the opioid market to branded, “abuse deterrent” formulations appeared to align with a long-standing priority of McKinsey’s work for Purdue, intended to stave off generic competition for OxyContin.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.016+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f10f3a1e-6f4f-4ba9-b348-71ea4a2f3368", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.66, "x": 0.17, "y": 0.53 }, "kind": "quote", "text": "“One really powerful move could be to require that all opioids reimbursed by HHS must have abuse deterrent formulations.” McKinsey Senior Partner Arnab Ghatak, January 2018", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Pull quote", "slug": "pull-quote", "status": "active", "canonId": "019de52c-fbf9-76fe-97e1-a0b7540445c9", "version": 1, "description": null }, "framework": null }, "subkind": "pull-quote", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.016+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "216d1fbc-d239-43e2-8b72-527dacb18682", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "One really powerful move could be to require that all opioids reimbursed by HHS must have abuse deterrent formulations. — McKinsey Senior Partner Arnab Ghatak, January 2018", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:52+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49d-7a57a760d975", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.11, "y": 0.81 }, "kind": "source-note", "text": "206 MCK-HCOR-0179997.\n207 MCK-HCOR-0174550 to MCK-HCOR-0174698 (McKinsey Purdue Engagement List).\n208 MCK-HCOR-0179910, Page 2.\n209 Id.", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.016+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c7fb39e1-dad5-4687-915a-bb447cbe4b0f", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 44, "type": "setup", "title": "The slide contains a pull-quote highlighting the core strategy and detailed footnotes citing internal McKinsey documents and external reports.", "function": "summarize", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "summarize", "functionCanon": { "name": "Summarize", "slug": "summarize", "status": "active", "canonId": "019de52d-1541-704f-b86f-bf7b75056373", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 82, "componentCount": 8, "textChars": 2193, "nDataPoints": 2, "notes": "The slide contains a pull-quote highlighting the core strategy and detailed footnotes citing internal McKinsey documents and external reports.", "elementsJson": [ "paragraph", "quote_block", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:42.104+00", "seconds": 3.574, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/44", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-44", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "The value of the ADF strategy evaluated here is based on a strategy of 'FDA conversion': e.g. removal of non-AD generics from the market.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:52+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49d-8ccc0af228d7", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "Revenue upside: $1.1B", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:52+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49d-906df3d25630", "parentComponentId": null }, { "bbox": { "h": 0.095, "w": 0.766, "x": 0.117, "y": 0.364 }, "kind": "paragraph", "text": "Under this strategy, McKinsey convinced Purdue to withdraw its own drug application for the original OxyContin, which it had promoted as safe for over a decade, based on alleged safety concerns. This, in turn, led FDA to investigate whether the old formulation of OxyContin, and all generic imitations, should be pulled from the market for safety reasons based on the original patent holder’s withdrawal.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.104+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "12343fdb-4b5a-4ea7-9b31-c324d86d68be", "parentComponentId": null }, { "bbox": { "h": 0.095, "w": 0.766, "x": 0.117, "y": 0.117 }, "kind": "paragraph", "text": "application for an abuse-deterrent formulation of OxyContin, withdraw its existing application for OxyContin “for reasons of safety” and thereby “Trigger an investigation by FDA for whether [the application] was pulled for safety; an affirmative finding results in withdrawal of all non-AD generics.”210 One presentation notes, “The value of the ADF strategy evaluated here is based on a strategy of ‘FDA conversion’: e.g. removal of non-AD generics from the market.”211", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.104+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "43553c88-fa73-4ad2-9223-cbee61faeb8a", "parentComponentId": null }, { "bbox": { "h": 0.095, "w": 0.766, "x": 0.117, "y": 0.468 }, "kind": "paragraph", "text": "A variation of this strategy appeared to work. On the day Purdue’s original patent for OxyContin was set to expire, FDA declared the benefits of OxyContin “no longer outweigh” the risks and limited generic competition.212 McKinsey described this as “FDA Conversion” of the market. McKinsey estimated the “Revenue upside to Purdue/Rhodes with market conversion could be $380-400M per year for ~3 years ($1.1B cumulatively).”213", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.104+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5f5c6ded-8147-404e-8630-87c6438a9a82", "parentComponentId": null }, { "bbox": { "h": 0.095, "w": 0.766, "x": 0.117, "y": 0.572 }, "kind": "paragraph", "text": "McKinsey recommended this strategy to Purdue despite unclear benefits of “abuse-deterrent” opioids and reformulated OxyContin in reducing addiction or abuse. In 2016, Dr. Tom Frieden, then-Director of the CDC, reported that his staff could not find “any evidence showing [abuse-deterrent formulations of opioids] actually reduce rates of addiction, overdoses, or deaths.”214 In 2020, the FDA released findings that “evidence was not robust that the reformulation caused a reduction in overall OxyContin abuse.”215", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.104+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9fe39917-d7c9-4ad1-9aaa-82cdaf217f47", "parentComponentId": null }, { "bbox": { "h": 0.095, "w": 0.618, "x": 0.191, "y": 0.218 }, "kind": "quote", "text": "“The value of the ADF strategy evaluated here is based on a strategy of ‘FDA conversion’: e.g. removal of non-AD generics from the market”", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Pull quote", "slug": "pull-quote", "status": "active", "canonId": "019de52c-fbf9-76fe-97e1-a0b7540445c9", "version": 1, "description": null }, "framework": null }, "subkind": "pull-quote", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.104+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b2e0e4a0-92ab-4a9f-82fa-c169ea8e9e69", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.766, "x": 0.117, "y": 0.742 }, "kind": "source-note", "text": "210-215 Citations regarding McKinsey documents, Empire of Pain, and FDA/CDC reports.", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.104+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "07afabe8-a9ab-40b1-8be0-d52707f134b5", "parentComponentId": null } ], "metrics": [ { "metricRaw": "Revenue upside", "numberRaw": "$1.1B", "numberKind": "money", "actionTitle": null, "calloutText": "The value of the ADF strategy evaluated here is based on a strategy of 'FDA conversion': e.g. removal of non-AD generics from the market.", "numberScale": "b", "numberValue": 1.1, "metricFamily": "revenue", "numberCurrency": "$" } ], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 45, "type": "setup", "title": "This slide appears to be a page from a formal report or legal document, containing narrative text and footnotes.", "function": "summarize", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "summarize", "functionCanon": { "name": "Summarize", "slug": "summarize", "status": "active", "canonId": "019de52d-1541-704f-b86f-bf7b75056373", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 78, "componentCount": 8, "textChars": 2264, "nDataPoints": 0, "notes": "This slide appears to be a page from a formal report or legal document, containing narrative text and footnotes.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:42.677+00", "seconds": 4.049, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/45", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-45", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "Thomas Latkovic, a senior partner, warned: 'This whole opioids thing is super sensitive with PMP [pharmaceutical and medical products] practice.'", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:53+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49e-32e18394d16a", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.76, "x": 0.12, "y": 0.18 }, "kind": "paragraph", "text": "Mr. Ghatak also suggested adding language to the Secretary Azar memo that acknowledged the value of the opioids his clients manufactured, noting, “we don’t mention that opioids do serve an important societal benefit, especially to chronic patients in severe pain.” He continued, “its [sic] just important to mention that side of the equation for balance.”216", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.677+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2d0138da-85d6-48f6-bb26-b0f5e2bf7aa1", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.03, "x": 0.48, "y": 0.93 }, "kind": "paragraph", "text": "45", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.677+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7ec329e5-d693-4a35-ac08-fc3668538ee1", "parentComponentId": null }, { "bbox": { "h": 0.09, "w": 0.76, "x": 0.12, "y": 0.47 }, "kind": "paragraph", "text": "That same day, Mr. Latkovic received a draft of the memo incorporating Mr. Ghatak’s suggestions.219 Mr. Latkovic pushed back on many of Mr. Ghatak’s recommendations, including Mr. Ghatak’s assertion that opioids provide a benefit to patients in pain. He wrote that “mentioning that opioids helps people in pain is actually a debatable point,” and noted that some policy actions to address the opioid crisis were “bad for Arnie’s client.”220", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.677+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cbf065b5-be52-400f-a39a-1327cfd8bca3", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.76, "x": 0.12, "y": 0.11 }, "kind": "paragraph", "text": "Mr. Ghatak's recommendation in the 2018 Secretary Azar transition memo to limit HHS reimbursements to ADF opioids appeared consistent with long-standing advice McKinsey provided to Purdue on how to limit generic competition to its opioid drugs.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.677+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d8e13eb8-7ca5-4b5c-a08b-697590d2a092", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.76, "x": 0.12, "y": 0.27 }, "kind": "paragraph", "text": "Some McKinsey partners expressed concern about Mr. Ghatak offering feedback on the Secretary Azar memo. Thomas Latkovic, a senior partner who works with non-profit and government clients, told other McKinsey consultants on a separate email chain that he did not believe soliciting Mr. Ghatak’s input was a “fair request or a good idea,” and warned: “This whole opioids thing is super sensitive with PMP [pharmaceutical and medical products] practice.” Mr. Latkovic relayed that Mr. Ghatak had previously told him that “the word ‘epidemic’ and/or ‘crisis’ are hyperbolic.” Mr. Latkovic later reiterated, “I’m trying to highlight the hornet’s nest you are entering.”217 Another consultant on the chain responded, “Yeah. Will become CSRC [Client Services Risk Committee] issue,” referring to an internal committee within McKinsey that helps manage the firm’s business risks.218", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.677+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f1b9d771-8203-4296-8da7-108864f3e12c", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "I'm trying to highlight the hornet's nest you are entering. — Thomas Latkovic", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:53+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49e-3524c5c047b2", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.35, "x": 0.12, "y": 0.8 }, "kind": "source-note", "text": "216 MCK-HCOR-0179910, Page 3 (emphasis added).\n217 MCK-HCOR-0261294.\n218 Id.\n219 MCK-HCOR-0261196.\n220 Id. (emphasis added).", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:42.677+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f257694a-34aa-47f8-ad7d-3951fd39571f", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 46, "type": "setup", "title": "This appears to be a page from a legal or investigative report (indicated by footnotes and redacted text).", "function": "other", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "other", "functionCanon": { "name": "Other (fallback)", "slug": "other", "status": "active", "canonId": "019de52d-15e1-75bc-99dc-07732380e2ce", "version": 1, "description": null }, "density": "dense", "densityScore": 66, "componentCount": 7, "textChars": 1074, "nDataPoints": 0, "notes": "This appears to be a page from a legal or investigative report (indicated by footnotes and redacted text).", "elementsJson": [ "paragraph", "screenshot" ], "confidence": 0.9, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:46.931+00", "seconds": 7.762, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/46", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-46", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "One paragraph detailing the costs and extent of the opioid epidemic was removed.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:52+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49d-f7a578e257c6", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.76, "x": 0.12, "y": 0.75 }, "kind": "paragraph", "text": "Several of Mr. Ghatak's suggested edits, including those introducing language on generic formulations of opioids and acknowledging that 'the opioid crisis is multi-factorial' remained.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:46.931+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a699ab0a-e72e-4384-a733-486a4c268ead", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.76, "x": 0.12, "y": 0.6 }, "kind": "paragraph", "text": "One paragraph detailing the costs and extent of the opioid epidemic was removed. The original version of the transition memo had read, 'Despite significant attention and effort, the opioid crisis continues to inflict devastating consequences...'", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:46.931+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d4bf50ae-4118-41df-ace0-e9416cc1b000", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.76, "x": 0.12, "y": 0.45 }, "kind": "paragraph", "text": "Later that evening, Ms. Carlton sent Mr. Ghatak an updated version of the memo, incorporating some of his feedback. Ms. Carlton thanked Mr. Ghatak for his suggestions, and stated, 'I've incorporated your suggestions into the rest of the language.'", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:46.931+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "de5c3724-0c88-4b94-92c7-22c61f26b31b", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.72, "x": 0.14, "y": 0.12 }, "kind": "paragraph", "text": "Steph - I don't have time until tonight to send more detail (if needed) but I don't think most of his suggestions were helpful and are unnecessary from a risk review standpoint.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:46.931+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f3d4a180-79de-4caa-b406-57d2ab268e79", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "The CDC guidelines are a joke and we should not anchor on them.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:52+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49d-f843d60f8f43", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.35, "x": 0.12, "y": 0.85 }, "kind": "source-note", "text": "221 MCK-HCOR-0179910. 222 Id. 223 Id.; MCK-HCOR-0179997. 224 MCK-HCOR-0179910.", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:46.931+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6144b17a-60fa-46ee-99be-d7ae0bf0a9e6", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 47, "type": "evidence", "title": "This appears to be a page from a formal investigative report or legal document, given the footnote style and content.", "function": "cite_precedent", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "cite_precedent", "functionCanon": { "name": "Cite precedent", "slug": "cite_precedent", "status": "active", "canonId": "019de52d-142b-714b-86d4-58aad7b568ec", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 78, "componentCount": 8, "textChars": 2919, "nDataPoints": 0, "notes": "This appears to be a page from a formal investigative report or legal document, given the footnote style and content.", "elementsJson": [ "paragraph", "screenshot", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:48.351+00", "seconds": 9.023, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/47", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-47", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "We'd love to arrange a meeting with the head of our healthcare practice to share perspectives and learn your personal priorities.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:52+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49e-11e0a9187f2c", "parentComponentId": null }, { "bbox": { "h": 0.335, "w": 0.634, "x": 0.183, "y": 0.362 }, "kind": "other", "text": "Begin forwarded message: From: \"Alex Azar\" [Redacted] Date: January 27, 2018 at 10:37:35 PM EST To: martin_elling@mckinsey.com Cc: dan_tinkoff@mckinsey.com Subject: [EXT]Re: One giant step! Congratulations Thanks guys. Very grateful for all your help. Let me get my sea legs over there and we can chat about the practice and connection to HHS. Best, Alex Work email will be: alex.azar@hhs.gov On Jan 25, 2018, at 9:17 AM, martin_elling@mckinsey.com wrote: Alex- I am just landing from Asia and saw the news. I am so very excited for you at your confirmation to Secretary of HHS. This is a monumental personal achievement that will allow you a platform to help improve the health of all Americans and influence trends that will help billions of people beyond our shores. From your testimony it is clear you have ambitious goals for the role which is exciting. We’d love to arrange a meeting with the head of our healthcare practice to share perspectives and learn your personal priorities. Let us know if that is helpful. Again, congratulations on this tremendous step onto a platform of profound influence on everyday people’s lives.", "attrs": null, "canon": { "kind": { "name": "Other", "slug": "other", "status": "active", "canonId": "019de52c-fa90-743c-8bf6-20d1fbe82b6d", "version": 1, "description": "Fallback when no canonical kind applies." }, "tool": null, "subkind": { "name": "Unclassified", "slug": "unclassified", "status": "active", "canonId": "019de52d-05ca-77db-81fb-db7d4234bbc0", "version": 1, "description": null }, "framework": null }, "subkind": "unclassified", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:48.351+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "186b4700-6471-4b49-9db1-cb207770c0a3", "parentComponentId": null }, { "bbox": { "h": 0.045, "w": 0.77, "x": 0.118, "y": 0.116 }, "kind": "paragraph", "text": "distributors, will have an important role to play.225 The section of the transition memo originally titled “Addressing drug prices” was renamed “Ensuring the value of pharmaceuticals.”226", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:48.351+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "011526ea-c83d-4756-a27f-95c1e09ac7fc", "parentComponentId": null }, { "bbox": { "h": 0.045, "w": 0.77, "x": 0.118, "y": 0.704 }, "kind": "paragraph", "text": "Other McKinsey consultants enjoyed a close relationship with HHS during Secretary Azar’s tenure, even those who may have potentially advised Purdue. In 2014, McKinsey stated in a presentation to Purdue that it would “bring to bear” the expertise of select McKinsey", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:48.351+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6a5e36ab-b96d-4f16-8b33-dc8d8e2837d9", "parentComponentId": null }, { "bbox": { "h": 0.032, "w": 0.77, "x": 0.118, "y": 0.184 }, "kind": "paragraph", "text": "The Committee has obtained evidence that the McKinsey memo was sent to Secretary Azar, but has not confirmed precisely when the transition memo was sent.227", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:48.351+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "95f09aed-0387-404c-a8f2-2900608bf628", "parentComponentId": null }, { "bbox": { "h": 0.085, "w": 0.77, "x": 0.118, "y": 0.237 }, "kind": "paragraph", "text": "On January 25, 2018, one day after Secretary Azar’s confirmation, McKinsey Senior Partner Martin Elling, whom Secretary Azar had earlier emailed seeking job advice, and another McKinsey partner emailed Secretary Azar to offer their congratulations. Mr. Elling wrote: “We’d love to arrange a meeting with the head of our healthcare practice to share perspectives and learn your personal priorities.” On January 27, 2018, Secretary Azar responded: “Thanks guys. Very grateful for all your help.”228", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:48.351+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "fc3991c3-c48b-488e-940f-4e9bdc18f900", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Thanks guys. Very grateful for all your help. Let me get my sea legs over there and we can chat about the practice and connection to HHS. — Alex Azar", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:52+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49e-14eb05cca85e", "parentComponentId": null }, { "bbox": { "h": 0.115, "w": 0.77, "x": 0.118, "y": 0.775 }, "kind": "source-note", "text": "225 MCK-HCOR-0085425, Page 5. 226 Id., Page 6. 227 MCK-HCOR-0173887. A senior McKinsey partner wrote to Mr. Elling about Azar: “BTW, here is the transition memo we wrote for him. I had emailed this to him last week but may be helpful for him to receive from you as well.” Mr. Elling replied: “Ok. I can send to him mentioning your reach out. So he knows we are coordinating.” 228 MCK-HCOR-0173887, Page 2.", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:48.351+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1a77eeb6-1955-4251-8c0b-f159de98d271", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 48, "type": "appendix", "title": "This page contains footnotes 229-236.", "function": "appendix", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "appendix", "functionCanon": { "name": "Appendix", "slug": "appendix", "status": "active", "canonId": "019de52d-138d-750b-83c3-49b4bc7a7a38", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 82, "componentCount": 8, "textChars": 2871, "nDataPoints": 1, "notes": "This page contains footnotes 229-236.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:49.722+00", "seconds": 9.873, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/48", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-48", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "Others at the firm raised limited concerns that this memo advocated positions favorable to McKinsey's private sector clients, but do not appear to have taken steps to prevent the memo from being sent.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:53+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49e-4f2ae0908807", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.78, "x": 0.11, "y": 0.609 }, "kind": "disclaimer", "text": "229 MCK-HCOR-0096857, Slide 15.\n230 Centers for Medicare & Medicaid Services, Press Release: CMS Welcomes New Leadership Team, Makes Additional Staffing Announcement (July 24, 2018) (www.cms.gov/newsroom/press-releases/cms-welcomes-new-leadership-team-makes-additional-staffing-announcement).\n231 USASpending, Contract Summary for PIID 75FCMC18F0099 Between Department of Health and Human Services and McKinsey & Company (online at www.usaspending.gov/award/CONT_AWD_75FCMC18F0099_7530_GS10F0118S_4730) (accessed Feb. 23, 2022).\n232 Department of Health & Human Services, Press Release: HHS Secretary Azar Statement on Continuing Leadership Expansion (July 5, 2019) (online at https://public3.pagefreezer.com/browse/HHS.gov/31-12-2020T08:51/https://www.hhs.gov/about/news/2019/07/05/hhs-secretary-azar-statement-on-continuing-leadership-expansion.html).\n233 MCK-HCOR-0170799, Page 3; S. 2680, 115th Cong. (2018).\n234 MCK-HCOR-0170799, Page 3.\n235 Id.\n236 MCK-HCOR-0170785, Page 3.", "attrs": null, "canon": { "kind": { "name": "Disclaimer", "slug": "disclaimer", "status": "active", "canonId": "91173477-d91f-4024-bbaf-d4f93e3f82dc", "version": 1, "description": "Legal/cautionary text that occupies most of the body of its slide." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:49.722+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "860cac6e-2df4-4af7-b153-c3cf270ab896", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.78, "x": 0.11, "y": 0.116 }, "kind": "paragraph", "text": "experts, including Paul Mango, a McKinsey partner in the “Payor Provider” practice and expert in “ACA Reform.”229 In July 2018, Mr. Mango joined CMS as Chief of Staff to then-CMS Administrator Seema Verma, who had been appointed by former President Trump.230", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:49.722+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "23ea23f7-3171-4d12-bd37-45a0660a5237", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.78, "x": 0.11, "y": 0.512 }, "kind": "paragraph", "text": "One of the primary drafters of the memo appears to be a McKinsey junior consultant, Consultant 16, who until earlier that year served as a consultant at Purdue.236 While consulting for Purdue, Consultant 16 had worked on “innovative contracting”—McKinsey’s term for", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:49.722+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "78d88233-dea6-4031-95ae-c966a6130651", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.78, "x": 0.11, "y": 0.184 }, "kind": "paragraph", "text": "According to federal spending data, in September 2018, McKinsey won a contract at CMS valued at $8.6 million—its first contract at CMS in six years.231 In July 2019, Secretary Azar named Mr. Mango his Deputy Chief of Staff for Policy, a position he served in until the end of the Trump Administration.232", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:49.722+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a212220d-ad7b-4bb4-9456-d10e0885f040", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.78, "x": 0.11, "y": 0.309 }, "kind": "paragraph", "text": "In October 2018, McKinsey consultants prepared an unsolicited policy memo for HHS and CMS on opioids. Others at the firm raised limited concerns that this memo advocated positions favorable to McKinsey’s private sector clients, but do not appear to have taken steps to prevent the memo from being sent.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:49.722+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e3f5b9f4-aca0-4a83-9763-62ad22ad39c7", "parentComponentId": null }, { "bbox": { "h": 0.09, "w": 0.78, "x": 0.11, "y": 0.393 }, "kind": "paragraph", "text": "On October 23, 2018, a McKinsey consultant in the health care practice internally shared a “perspective memo” on the Opioid Crisis Response Act (OCRA), a broad bipartisan bill that directed funding to federal agencies to establish or expand programs dealing with substance use disorder prevention, treatment and recovery.233 The McKinsey consultant noted that her team “would like to share it with senior folks at HHS and potentially Seema,”234 likely a reference to CMS Administrator Seema Verma.235", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:49.722+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ff7778d9-e627-41a6-b6a9-0557ef7d1821", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.54, "x": 0.23, "y": 0.274 }, "kind": "title", "text": "2. McKinsey Prepared an Unsolicited Opioid Policy Memo for HHS", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:49.722+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e57b7053-3f63-4922-a183-4ee5b20b14e1", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 49, "type": "appendix", "title": "This appears to be a page from a formal report or legal document, indicated by the footnote numbering and page number at the bottom.", "function": "appendix", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "appendix", "functionCanon": { "name": "Appendix", "slug": "appendix", "status": "active", "canonId": "019de52d-138d-750b-83c3-49b4bc7a7a38", "version": 1, "description": null }, "density": "dense", "densityScore": 71, "componentCount": 7, "textChars": 3706, "nDataPoints": 0, "notes": "This appears to be a page from a formal report or legal document, indicated by the footnote numbering and page number at the bottom.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:49.978+00", "seconds": 9.771, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/49", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-49", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "I started reading your memo and will confess that I'm a bit puzzled... Is this memo part of a client engagement? A roundabout way of submitting an LOP [letter of proposal] for a future engagement?", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:55+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49e-a0bd4618e0bf", "parentComponentId": null }, { "bbox": { "h": 0.215, "w": 0.766, "x": 0.117, "y": 0.417 }, "kind": "paragraph", "text": "After receiving clarification that the memo was not part of client engagement or a proposal, Ms. Rosen responded. “Apropos your original question about whether the memo needs additional review, the answer is no. In fact, given that the memo is being sent from a CST [client service team] to a client (even a public-sector client), there is no reason that either [Ms. Lane] or I would have to risk-review it.” Ms. Rosen continued: I didn’t spot anything particularly risky in the memo, given the bad press the firm has received because of south Africa and, especially, Saudi Arabia, my personal view is that for the time being we should minimize the number of things we send to public-sector clients (other than engagement deliverables). But people with pay grades far above mine have decided differently, and their judgment wins.241", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:49.978+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6a074917-6e70-4f57-bbae-122c283791d4", "parentComponentId": null }, { "bbox": { "h": 0.042, "w": 0.766, "x": 0.117, "y": 0.117 }, "kind": "paragraph", "text": "contracts that would, in part, provide insurers and pharmacy benefit managers a rebate “for every OxyContin overdose attributable to pills they sold.”237", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:49.978+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "78bdcc48-adc1-4ad5-be3c-e5a7d0e07637", "parentComponentId": null }, { "bbox": { "h": 0.145, "w": 0.766, "x": 0.117, "y": 0.169 }, "kind": "paragraph", "text": "The McKinsey health care practice team shared the OCRA policy memo with Ellen Rosen, McKinsey’s Global Manager of Publications, and Julie Lane, the Global External Relations Manager of the health care practice, who, according to a “modified risk review process” devised by the team “were supposed to “make sure (sic) no big red flags.”238 This process also included, “eliminat[ing] any logos or other forms of branding from the memos,” and having “1 thought partner from each sector read each memos [sic].”239 Upon review of the memo, both Ms. Rosen and Ms. Lane raised concerns about the utility and propriety of sharing the memo with HHS and CMS.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:49.978+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d8a328eb-bfa8-41f5-b866-bb2e7ff9e8e2", "parentComponentId": null }, { "bbox": { "h": 0.085, "w": 0.766, "x": 0.117, "y": 0.323 }, "kind": "paragraph", "text": "On October 29, 2018, Ms. Rosen wrote back to one of the memo’s drafters, “I started reading your memo and will confess that I’m a bit puzzled... Is this memo part of a client engagement? A roundabout way of submitting an LOP [letter of proposal] for a future engagement? Otherwise, why are we giving advice to a federal agency about a federal law, especially since we are not lawyers?”240", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:49.978+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "eba4d23a-94af-41fa-90dc-3825c0d1d070", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "I didn't spot anything particularly risky in the memo, given the bad press the firm has received because of south Africa and, especially, Saudi Arabia, my personal view is that for the time being we should minimize the number of things we send to public-sector clients (other than engagement deliverables). But people with pay grades far above mine have decided differently, and their judgment wins.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:55+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49e-a59aaec6b8a1", "parentComponentId": null }, { "bbox": { "h": 0.265, "w": 0.766, "x": 0.117, "y": 0.675 }, "kind": "source-note", "text": "237 See McKinsey Settles for Nearly $600 Million over Role in Opioid Crisis, New York Times (Feb. 3, 2021) (online at www.nytimes.com/2021/02/03/business/mckinsey-opioids-settlement.html); MCK-HCOR-0000246; MCK-HCOR-0000251; MCK-HCOR-0001019, Pages 6-11. 238 MCK-HCOR-0170785, Page 3. 239 Id. 240 MCK-HCOR-0170799, Page 2. 241 Id., Page 1. (emphasis added). McKinsey’s work for foreign governments had come under scrutiny that month after reports that the Saudi Arabian government may have used a McKinsey report to identify and jail dissidents. See Saudis’ Image Makers: A Troll Army and a Twitter Insider, New York Times (Oct. 20, 2018) (online at www.nytimes.com/2018/10/20/us/politics/saudi-image-campaign-twitter.html?dlbk). McKinsey was also embroiled in a corruption scandal related to its work for the South African government which journalists credited to the firm’s “aggressive push into more government consulting.” See How McKinsey Lost Its Way in South Africa, New York Times (June 26, 2018) (online at www.nytimes.com/2018/06/26/world/africa/mckinsey-south-africa-eskom.html).", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:49.978+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "76ee48ab-b899-448e-8ef9-3e75e2ad1995", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 50, "type": "setup", "title": "This appears to be a page from a congressional or investigative report (page 50).", "function": "summarize", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "summarize", "functionCanon": { "name": "Summarize", "slug": "summarize", "status": "active", "canonId": "019de52d-1541-704f-b86f-bf7b75056373", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 86, "componentCount": 10, "textChars": 2637, "nDataPoints": 0, "notes": "This appears to be a page from a congressional or investigative report (page 50).", "elementsJson": [ "paragraph", "quote_block", "footnote" ], "confidence": 0.9, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:48.955+00", "seconds": 8.511, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/50", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-50", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "The Committee has also obtained evidence that McKinsey consultants discussed destroying or hiding documents concerning the firm's work for Purdue.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:53+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49e-60befe10a64e", "parentComponentId": null }, { "bbox": { "h": 0.13, "w": 0.78, "x": 0.11, "y": 0.38 }, "kind": "paragraph", "text": "McKinsey had previously sent other opioid policy memos to CMS, even when the firm was seemingly not providing consulting services to CMS. A January 2018 email from a McKinsey consultant to Tom Latkovic stated, “The statistics and recommendations included in our Azar memo were largely culled from the Oct 2017 white paper for CMS, ‘Saving lives now: Perspectives on Accelerating CMS’s Impact in Solving the Opioid Crisis.’”243 According to publicly available federal spending data, McKinsey did not have any ongoing federal contracts at CMS at the time it reportedly submitted the 2017 white paper.244", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:48.955+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "02469bab-297c-4e24-a3c2-8fd159f1fa21", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.78, "x": 0.11, "y": 0.53 }, "kind": "paragraph", "text": "This evidence raises significant questions about how McKinsey’s practice of seeking input from consultants who had served or were serving opioid manufacturers impacted the work product of McKinsey’s government and policy facing health care practice, and about how these recommendations influenced the federal government’s opioid policies.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:48.955+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "38a73520-e499-4873-8906-c35b9e3dc0ed", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.78, "x": 0.11, "y": 0.69 }, "kind": "paragraph", "text": "In May 2017—more than two years before McKinsey announced it would no longer work for opioid manufacturers—Mr. Ghatak and McKinsey partner Laura Moran discussed over text message how to ensure McKinsey documents would not get pulled into Purdue’s ongoing litigation.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:48.955+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "94083bd4-ed89-44fe-9272-9683fa232970", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.78, "x": 0.11, "y": 0.64 }, "kind": "paragraph", "text": "The Committee has also obtained evidence that McKinsey consultants discussed destroying or hiding documents concerning the firm’s work for Purdue.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:48.955+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "96e602c3-7999-40c0-8ef9-eb72a7195b1d", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.11, "y": 0.11 }, "kind": "paragraph", "text": "Ms. Lane also expressed concerns. The next day, on October 30, 2018, she wrote, “My main concern is that this could be misinterpreted as if we are advocating on behalf of our private sector and other clients to HHS to take specific actions around provider programs, state programs, etc.”242 It is unclear what further action McKinsey took with the OCRA memo.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:48.955+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a9b2fd91-c012-4584-a00d-ecc7bd576a39", "parentComponentId": null }, { "bbox": { "h": 0.13, "w": 0.54, "x": 0.23, "y": 0.2 }, "kind": "quote", "text": "My main concern is that this could be misinterpreted as if we are advocating on behalf of our private sector and other clients to HHS to take specific actions around provider programs, state programs, etc. Julie Lane, McKinsey Healthcare Practice", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Pull quote", "slug": "pull-quote", "status": "active", "canonId": "019de52c-fbf9-76fe-97e1-a0b7540445c9", "version": 1, "description": null }, "framework": null }, "subkind": "pull-quote", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:48.955+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "26553b94-675a-42a9-8654-26fc5dd06c63", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "My main concern is that this could be misinterpreted as if we are advocating on behalf of our private sector and other clients to HHS to take specific actions around provider programs, state programs, etc. — Julie Lane, McKinsey Healthcare Practice", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:53+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49e-66cf281eaa87", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.78, "x": 0.11, "y": 0.81 }, "kind": "source-note", "text": "242 MCK-HCOR-0170799. 243 MCK-HCOR-0261306, Page 2. 244 USA Spending, McKinsey & Company Contracts with the Centers for Medicare and Medicaid Services Since 2008 (online at www.usaspending.gov/search/?hash=e8ef63dc11ba5bf988e7296b8d0e9036) (accessed Mar. 22, 2022).", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:48.955+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "09e6270f-0e3f-4b22-bc1f-9fd64c90c7f0", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.11, "y": 0.61 }, "kind": "title", "text": "E. Document Destruction", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:48.955+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0669be1d-8842-4bd3-b95f-9624ce28d193", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 51, "type": "evidence", "title": "This page contains footnotes referencing specific internal documents (MCK-HCOR codes) and news articles.", "function": "cite_precedent", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "cite_precedent", "functionCanon": { "name": "Cite precedent", "slug": "cite_precedent", "status": "active", "canonId": "019de52d-142b-714b-86d4-58aad7b568ec", "version": 1, "description": null }, "density": "dense", "densityScore": 67, "componentCount": 7, "textChars": 1208, "nDataPoints": 0, "notes": "This page contains footnotes referencing specific internal documents (MCK-HCOR codes) and news articles.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:43.572+00", "seconds": 3.103, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/51", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-51", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "Documents indicate that efforts to delete documents and shield McKinsey's work for Purdue may have accelerated in 2018.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:54+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49e-7b7641372490", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.78, "x": 0.11, "y": 0.61 }, "kind": "paragraph", "text": "New documents obtained by the Committee suggest that Mr. Elling may have taken further steps to eliminate his documents relating to Purdue.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.572+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4342187f-5105-413b-a262-df653156f3c8", "parentComponentId": null }, { "bbox": { "h": 0.07, "w": 0.78, "x": 0.11, "y": 0.48 }, "kind": "paragraph", "text": "On July 4, 2018, five months after collaborating on the transition memo to HHS Secretary Alex Azar, Mr. Elling and Mr. Ghatak exchanged emails, which have previously been reported, about destroying documents relating to McKinsey's work for Purdue.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.572+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4739b9de-e827-4b9f-8a2d-b29a1f499cfa", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.78, "x": 0.11, "y": 0.27 }, "kind": "paragraph", "text": "Documents obtained by the Committee suggest that \"WP\" referred to \"Working Papers,\" the McKinsey processing system whereby \"Documents classified as 'Client' for more than six months will be deleted.\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.572+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a29600c1-0f31-4f18-a3a3-e1b161743660", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.11, "y": 0.11 }, "kind": "paragraph", "text": "In one exchange, Ms. Moran stated that McKinsey had informed Purdue that consultants would not \"email the opioid decks\" and McKinsey would \"just do hard copy on these.\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.572+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a7ba3044-5d3c-43e7-996d-b3c186e02779", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.78, "x": 0.11, "y": 0.34 }, "kind": "paragraph", "text": "Documents indicate that efforts to delete documents and shield McKinsey's work for Purdue may have accelerated in 2018.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.572+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d687c12a-cca1-4811-b12c-fda726ad403b", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.78, "x": 0.11, "y": 0.76 }, "kind": "source-note", "text": "245 MCK-HCOR-0351073. 246 MCK-HCOR-0097466. 247 MCK-HCOR-0173804. 248 MCK-HCOR-0173795; McKinsey Settles for Nearly $600 Million Over Role in Opioid Crisis... 249 New York Sues Oxycontin Maker... 250 MCK-HCOR-0173790.", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:43.572+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8f4eb40f-c28f-4a9a-96a2-04fde610b941", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 52, "type": "setup", "title": "Page 52 of a report, likely a congressional or investigative document.", "function": "summarize", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "summarize", "functionCanon": { "name": "Summarize", "slug": "summarize", "status": "active", "canonId": "019de52d-1541-704f-b86f-bf7b75056373", "version": 1, "description": null }, "density": "dense", "densityScore": 72, "componentCount": 7, "textChars": 1336, "nDataPoints": 2, "notes": "Page 52 of a report, likely a congressional or investigative document.", "elementsJson": [ "screenshot", "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:44.096+00", "seconds": 3.331, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/52", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-52", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "The Committee's investigation has confirmed that McKinsey had significant and long-running conflicts of interest due to its overlapping and conflicting work for FDA and opioid manufacturers.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:56+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49e-bb8c6133e8b7", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.68, "x": 0.16, "y": 0.11 }, "kind": "image", "text": "Redacted email from Martin Elling", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Screenshot", "slug": "screenshot", "status": "active", "canonId": "019de52c-fd87-7509-8391-3d79fb339379", "version": 1, "description": null }, "framework": null }, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:44.096+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "02ee53fd-0238-477a-97f4-34bd1276dfb8", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.78, "x": 0.11, "y": 0.4 }, "kind": "paragraph", "text": "The documents obtained in this investigation raise questions about the full scope of McKinsey’s efforts to shield or destroy documents. The evidence also raises concerns about the extent to which McKinsey’s document management practices may have been used to conceal key documents and information about conflicts and harmful conduct from Congress and the public’s view.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:44.096+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "11bc7bc6-0fed-4582-a602-f0a1e271ff7f", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.78, "x": 0.11, "y": 0.66 }, "kind": "paragraph", "text": "The Committee found that McKinsey frequently staffed consultants on both FDA and opioid manufacturer projects, including at the exact same time, increasing the risk of biased advice to federal officials who had hired McKinsey to help stem the nation’s opioid addiction crisis.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:44.096+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d97ff08b-9050-407c-a336-b3e095ca3391", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.11, "y": 0.54 }, "kind": "paragraph", "text": "The Committee’s investigation has confirmed that McKinsey had significant and long-running conflicts of interest due to its overlapping and conflicting work for FDA and opioid manufacturers. These conflicts spanned more than ten years and 37 FDA contracts, costing taxpayers more than $65 million.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:44.096+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e0b0d6a5-69fa-4dde-945a-b51264fecc71", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.11, "y": 0.83 }, "kind": "source-note", "text": "251 McKinsey’s settlement agreement with 53 states attorneys general in February 2021 required the firm to implement a detailed document retention policy...", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:44.096+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "35c652e9-f0c0-434d-99e9-da7ac0c6ded0", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.2, "x": 0.11, "y": 0.508 }, "kind": "title", "text": "III. CONCLUSION", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:44.096+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6853be21-58a5-4f67-9da0-0a33ebb5547d", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 53, "type": "setup", "title": "This appears to be a page from a formal government or committee report, likely an appendix or disclosure section.", "function": "summarize", "rawType": "appendix_disclosure", "block": null, "metadata": { "slideType": "appendix_disclosure", "slideTypeCanon": { "name": "Appendix disclosure", "slug": "appendix_disclosure", "status": "active", "canonId": "019de52d-07b2-7549-8e8b-932a19f6e616", "version": 1, "description": null }, "function": "summarize", "functionCanon": { "name": "Summarize", "slug": "summarize", "status": "active", "canonId": "019de52d-1541-704f-b86f-bf7b75056373", "version": 1, "description": null }, "density": "dense", "densityScore": 51, "componentCount": 5, "textChars": 1276, "nDataPoints": 0, "notes": "This appears to be a page from a formal government or committee report, likely an appendix or disclosure section.", "elementsJson": [ "paragraph" ], "confidence": 0.9, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 19:14:44.146+00", "seconds": 3.119, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-5ca1-7489-b639-45501f4b359b/53", "deck": "/decks/019dd923-5ca1-7489-b639-45501f4b359b", "deckAnchor": "/decks/019dd923-5ca1-7489-b639-45501f4b359b#slide-53", "deckJson": "/decks/019dd923-5ca1-7489-b639-45501f4b359b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "The Committee remains committed to uncovering the full scope of McKinsey's consulting in furtherance of abusive practices and conflicts of interest across the federal government.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-24 13:22:54+00", "model": "or:google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd951-cdec-74db-b49e-926fe2ba1a90", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.024, "x": 0.488, "y": 0.938 }, "kind": "other", "text": "53", "attrs": null, "canon": { "kind": { "name": "Other", "slug": "other", "status": "active", "canonId": "019de52c-fa90-743c-8bf6-20d1fbe82b6d", "version": 1, "description": "Fallback when no canonical kind applies." }, "tool": null, "subkind": { "name": "Unclassified", "slug": "unclassified", "status": "active", "canonId": "019de52d-05ca-77db-81fb-db7d4234bbc0", "version": 1, "description": null }, "framework": null }, "subkind": "unclassified", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:44.146+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "75d052f0-c90d-467c-ae63-f7dd6d612692", "parentComponentId": null }, { "bbox": { "h": 0.033, "w": 0.766, "x": 0.117, "y": 0.117 }, "kind": "paragraph", "text": "government health care practice incorporating feedback from consultants serving private sector opioid clients and altering work product in ways that appeared to serve those clients' interests.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:44.146+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1f4de326-43b5-4fa6-90d7-3bbf8f572b0d", "parentComponentId": null }, { "bbox": { "h": 0.067, "w": 0.766, "x": 0.117, "y": 0.317 }, "kind": "paragraph", "text": "McKinsey's conduct raises significant questions about the lack of regulation over consulting companies that advise both the federal government and private sector clients. The Committee remains committed to uncovering the full scope of McKinsey's consulting in furtherance of abusive practices and conflicts of interest across the federal government.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:44.146+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5fa51458-761b-404b-b8bb-a91a764958fd", "parentComponentId": null }, { "bbox": { "h": 0.133, "w": 0.766, "x": 0.117, "y": 0.167 }, "kind": "paragraph", "text": "This interim report addresses McKinsey's conflicts with respect to only one type of client: opioid manufacturers. Over five months ago, the Committee requested information on McKinsey's consulting for other pharmaceutical companies, drug distributors, and drug retailers—as well as key documents on McKinsey's risk management practices. McKinsey has failed to provide most of the key documents that would allow the Committee to fully assess how its consulting practices and conflicts of interest have affected the health and safety of the American people.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 19:14:44.146+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "78b97d2f-fdf9-4711-80b8-6aac89792fb4", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 53, "arc": { "name": "Problem-Agitate-Solution", "slug": "problem-agitate-solution", "status": "active", "bestFor": "Sales pitches, urgency-driven, competitive displacement", "canonId": "019dd956-5ec6-70f9-9fd8-fdbaaff39acf", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "Problem (Identify pain) -> Agitate (Make it worse) -> Solution (Provide relief)", "description": null, "familyLabel": null }, "from": 29, "name": "Impact & Next Steps", "beatId": "1170eac2-9202-4b41-a53c-edbd934ded10", "matchId": "de285613-74cb-4055-aa43-017716798b85", "beatType": { "name": "Impact & Next Steps", "slug": "consultants-gambit-impact-next-steps", "status": "active", "canonId": "019dd9b8-0849-7728-9ee9-fd1609c4c655", "version": 1, "description": null }, "evidence": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action.", "position": 2, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 53, "from": 1, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "ee9686db-f8b5-4bc9-bf6e-2d29966ee033", "evidence": "The document implies the cost of inaction through its presentation of McKinsey's conflicts of interest and their potential impact on the opioid epidemic.", "position": 0, "objective": "What is the cost of inaction in addressing McKinsey's conflicts of interest?", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:07:34.491957+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true } ], "arcBeats": [ { "from": 1, "to": 5, "label": "Problem & Complication", "description": "The document introduces the problem of McKinsey's conflicts of interest and complicates it through examples of overlapping work." }, { "from": 6, "to": 28, "label": "Evidence & Proof", "description": "The document presents extensive evidence of McKinsey's conflicts of interest, including consultant overlaps and contract details." }, { "from": 29, "to": 53, "label": "Impact & Next Steps", "description": "The document concludes with implications of McKinsey's actions and potential next steps for regulatory action." } ], "loops": [ { "from": 1, "to": 53, "label": "Cost Of Inaction", "description": "What is the cost of inaction in addressing McKinsey's conflicts of interest?" }, { "from": 24, "to": 40, "label": "Voice Of Customer", "description": "What are the concerns of regulatory bodies regarding McKinsey's conflicts of interest?" } ] }