Health Care Corruption
When a pharmaceutical, biotechnology, or device company withholds results of a clinical trial to makes its product look better and enhance its revenue, that is an example of health care corruption.
Transparency International defines corruption as
Abuse of entrusted power for private gain
When health care corporations run clinical trials, we entrust them to do honest research and be worthy of the trust of their research subjects. Withholding the results to enhance revenue is therefore abuse of that entrusted power for private gain.
Health Care Corruption as a Taboo Topic
This blog focuses on the US, and we now have in our archives some amazing stories that document various forms of health care corruption in the US, including numerous allegations of misbehavior by large health care organizations ending in legal settlements, and examples of outright fraud, bribery, kickbacks and other crimes. Some large and profitable health care corporations have made numerous such settlements over recent years. (For example, see the track record to date of Pfizer Inc here and that of Johnson and Johnson here.)
Much of this bad behavior was meant to sell drugs, devices, or clinical services, often in situations in which their benefits did not outweigh their harms. For example, we just discussed the latest settlement by Amgen of allegations that it promoted an epoetin (Aranesp) “off-label” for cancer patients not on chemotherapy. Such “misbranding” was not merely a technical violation, since it has been shown that use of the drug in this situation increases mortality. Such bad behavior thus likely harmed numerous patients.
Furthermore, efforts to police these kinds of corruption have been weak and scattered. Most cases have ended with legal settlements that at most involve fines to corporations, yet the fines are rarely big enough to significantly affect their overall revenues. While the corporations themselves may be thus punished, the people who actually authorized, directed or implemented the bad behavior are usually unscathed. So as we have discussed frequently, such attempts at justice are unlikely to deter future bad behavior.
In fact, people more distinguished than yours truly have been warning about health care corruption for years. In particular, in 2006, the Transparency International Global Corruption Report focused on health care corruption, and asserted in its executive summary, ” the scale of corruption is vast in both rich and poor countries.” It also noted how diverse is health care corruption:
In the health sphere corruption encompasses bribery of regulators and medical professionals, manipulation of information on drug trials, the diversion of medicines and supplies, corruption in procurement, and overbilling of insurance companies. It is not limited to abuse by public officials, because society frequently entrusts private actors in health care with important public roles. When hospital administrators, insurers, physicians or pharmaceutical company executives dishonestly enrich themselves, they are not formally abusing a public office, but they are abusing entrusted power and stealing precious resources needed to improve health.
It further stated how serious the consequences of corruption may be for patients and public health:
Corruption deprives people of access to health care and can lead to the wrong treatments being administered. Corruption in the pharmaceutical chain can prove deadly….
The poor are disproportionately affected by corruption in the health sector, as they are less able to afford small bribes for health services that are supposed to be free, or to pay for private alternatives where corruption has depleted public health services.
Corruption affects health policy and spending priorities.
Occasionally, something is published about health care corruption in the US in the medical literature.
– In 2009, qualitative interviews by Pololi et al in the Journal of General Internal Medicine produced many striking anecdotes suggesting corruption in US academic medicine. Four of the interviews were with faculty whose leaders allegedly used deception for personal and professional gain (i.e., “a situation of major unethical use of funding,” “fraudulently creating data for a research project,” “we’re lying to the people who are doing our school evaluations, we’re putting things on paper that we do that we don’t do,” “that’s what I think he felt he had to do—hide money, lie about money, or at least cook the books a little bit.”)(4) These results produced few echoes, particularly not any strident editorials about the need to address corruption.
– In 2011, an article in the Lancet suggested that “there is more corruption in the G8 countries than in the whole of Africa,” but for any health care professional to acknowledge that would be “professional suicide” (see this post).(3)
– Finally, in 2013, a Transparency International survey showed that 43% of Americans believe their health care system is corrupt. Yet this received no media attention, and to my knowledge has never been mentioned in a major US medical journal. (Look here.)
So health care corruption remains a largely taboo topic. (On Health Care Renewal, we call corruption “anechoic,” since evidence of health care corruption produces few echoes.)
The Annals of Internal Medicine, like most major medical journals, has long avoided discussion of health care corruption, and how systemic corruption harms patients’ and the public’s health.
Of course, the unwillingness to discuss global health care corruption, health care corruption in the US, and the relationship of health care corruption in the US to corruption in other sectors may arise from the fear, as stated by one person interviewed in Charles Ferguson’s documentary Inside Job, that discussion could lead to investigation, and investigation could “find the culprits”.
