Daniel Tsai, Mayor Daniel Lurie’s choice to lead the Department of Public Health, has a blue-chip résumé: After studying at Harvard University, he landed a prestigious consulting gig before jumping into government, leading Medicaid programs in Massachusetts, then federally under former President Joe Biden. 

Along the way, Tsai, in his capacity as an employee with McKinsey & Company, helped to market a powerful painkiller called tramadol during the company’s years-long streak of pushing opioid sales. The company’s actions ultimately led to a criminal probe, more than $1 billion in settlements, and a public mea culpa over its role in fueling an overdose epidemic that has killed more than 500,000 Americans over 25 years.

Tsai’s actions at McKinsey are detailed in a tranche of documents that were released as part of a settlement with the consulting firm in which it was accused of accelerating opioid sales despite growing awareness of the risks. 

The records show that Tsai — who worked for McKinsey from 2007 to 2015, according to his LinkedIn page — helped develop a marketing strategy for tramadol sold under the brand name Ultram ER, an effort that involved cultivating relationships with doctors who became prolific prescribers. The records are housed at the UCSF-JHU Opioid Industry Documents Archive.

In a March 2008 PowerPoint presentation, Tsai outlined a marketing strategy for the drug that included guidance on targeting “specific physician segments to grow high-prescriber group (i.e., physicians more sensitive to patient needs)” and an idea to introduce “coupons” for the drug as part of a pilot program.

“We hope to be interviewing some high-prescriber physicians next week,” Tsai wrote in an email the same month, attaching a list of questions that could be used to screen doctors.

Lurie’s office defended Tsai’s appointment as Public Health chief. In a statement, the mayor’s office wrote, “Nearly 20 years ago, Dan Tsai was a 23-year-old entry-level staffer assigned to conduct research for a project at work. He has spent nearly his entire two-decade career supporting those struggling with homelessness and addiction and helping tens of millions of our most vulnerable neighbors access critical medical care, and he will continue that work in San Francisco.”

Several drug and homelessness service providers in the city said they were disappointed by a lack of transparency surrounding Tsai’s appointment process. The revelation of his past role at McKinsey intensified those concerns, they said. 

“You’d want a public health official of that caliber to articulate what his partic