Posted on Saturday 11 June 2016
The first blog I encountered when I realized how much corruption there was in the medical literature was Health Care Renewal. It wasn’t about the psychiatric medications, but it was about the problem I was stirred up about at the time. I found others, but most of them had some underlying agenda of their own. Health Care Renewall didn’t seem to have that problem. I went back and read the inaugural post and that cinched it – Roy Poses was talking about what I needed to read about. His referenced paper is available full text on-line, as right today as the day he wrote it [it’s telling which journal ended up publishing it]:
Friday, December 10, 2004
Health care around the world is beset by rising costs, declining access, stagnant quality, and increasingly dissatisfied health care professionals. Discussions with physicians and other professionals revealed pervasive concerns that the core values of health care are under seige. Patients and physicians are caught in cross-fires between conflicting interests, and subject to perverse incentives. Free speech and academic freedom are threatened. Psuedo-science and anti-science are gaining ground. Causes include the increasing dominance of health care by large organizations, often lead by the ill-informed, the self-interested, and even the corrupt.  However, such concentration and abuse of power in health care has rarely been discussed openly. This blog is dedicated to the open discussion of health care’s current dysfunction with the hopes of generating its cures.
1. Poses RM. A cautionary tale: The dysfunction of American health care. European Journal of Internal Medicine. 2003; 14: 123-130.
Since then, I’ve read his blog religiously. I don’t mention it often because the only thing to say is "yes!" He has a recurrent theme that it took me a while to fully comprehend – anechoic. It means what it says. When yet another example of corrupted medicine appears, it may be a big story [briefly], but then it goes away [quickly] – it doesn’t echo. It gets lost in the wind. A prime example is Jureidini, Amsterdam, and McHenry’s recent paper:
The citalopram CIT-MD-18 pediatric depression trial: Deconstruction of medical ghostwriting, data mischaracterisation and academic malfeasanceby Jureidini, Jon, Amsterdam, Jay, McHenry, LeemonInternational Journal of Risk & Safety in Medicine. 2016 28:33-43.
Using subpoenaed verbatim internal documents, they demonstrate an example of a pharmaceutical company actively distorting an analysis. It should be a nidus for a collective call to arms, but it’s not even much yet read.
Transparency International Reports on Massive Corruption in the Pharmaceutical Sector – Media Hardly NoticesHealth Care Renewalby Roy PosesJune 08, 2016
Transparency International UKJune 2016
The launch of the Sustainable Development Goals in September 2015 signals a more comprehensive global development agenda. This plan specifies that all governments must fight corruption. For the health sector, this will mean integrating good governance into policy making and implementation to reduce the risk of corruption.
Within the health sector, pharmaceuticals stands out as sub-sector that is particularly prone to corruption. There are abundant examples globally that display how corruption in the pharmaceutical sector endangers positive health outcomes. Whether it is a pharmaceutical company bribing a doctor for prescribing its medicines irrespective of a health need or a government employee facilitating the infiltration of substandard medicines into the distribution system, public resources can be wasted and patient health put at risk.
For policy makers to implement successful anti-corruption measures there is a need to identify and understand corruption vulnerabilities in the pharmaceutical sector. To support this task this paper identifies key policy and structural issues in selected activities of the pharmaceutical value chain, along with relevant anti-corruption policies. This analysis showed that anti-corruption policies are needed throughout the pharmaceutical value chain to increase transparency around key decision points and strengthen the accountability of actors.Four overarching challenges derived from structural issues and anti-corruption policies across the selected activities of the value chain have been identified. These are:
- A lack of objective data and understanding of corruption inhibited by environmental context, the complexity of issues in the sector and policy makers not viewing corruption as an issue.
- A weak legislative and regulatory framework because of poor investment, a lack of oversight and national regulatory frameworks that are often decentralised and reliant on self-regulation for key decision-point.
- The potential for undue influence from companies due to a high degree of autonomy over key decision points and unparalleled resources, on policy and regulation so profit maximisation goes beyond ethical norms and negatively impacts health outcomes and public health objectives.
- A lack of leadership committed to anti-corruption efforts from all actors. National leaders often only implement reforms after a crisis, with their inaction regularly hindering other actors.Similarly, three key action areas to mitigate corruption vulnerabilities in the pharmaceutical sector are examined. These include establishing leadership committed to addressing corruption, adopting technology throughout the value chain and ensuring accountability through increased monitoring, enforcement and sanctions. These overarching challenges and action areas are neither novel nor resource-intensive, stressing the lack of effective action in the past; as well as the difficulty of dealing with corruption in a sector that is extremely complex, has a high level of government intervention and often has regulatory systems in place that are inadequate to properly govern the value chain. Only by overcoming these challenges and focusing on these action areas will the global health community be better able to meet the health Sustainable Development Goals.