Wednesday, June 9, 2010
Corporate control of Health care
The Corporatization of Health By Gavin Mooney
As a health economist one ceases to be shocked by the quite disgusting behaviour of the pharmaceutical industry. It happen so often. But every now and then Big Pharma manages to find yet more offensive ways of trying to corrupt research, clinicians and the WHO.
At the same time I note how willing some in health services – doctors and others – are to take the Big Pharma shilling and without any recognition often of the conflicts of interests involved. A couple of examples from my own experience. Nearly 20 years ago, a leading Australian clinician was keen to do a study with me which would have involved bringing a colleague out from the UK. He said he’d get the money for the airfare from a drug company. I indicated that if there were any drug company money involved then I would not be. He was amazed at this response and said: ”I can’t remember when I last paid for an airfare.”
More recently I suggested to a very senior university administrator that the university should not accept drug company money when evaluating drugs since there was good evidence that such funding resulted in bias in favour of the company’s drug. “Studies sponsored by pharmaceutical companies were more likely to have outcomes favouring the sponsor than were studies with other sponsors” (1). The university administrator’s response? “But if we say no Gavin, the company will just go down the road to another university!”
There are countless such stories and on a much bigger scale. One is the recent case of WHO and the swine flu pandemic. The Guardian of June 4 (2) reported: “An investigation by the British Medical Journal and the Bureau of Investigative Journalism … shows that WHO guidance [on stockpiling drugs in the event of a flu pandemic] issued in 2004 was authored by three scientists who had previously received payment for other work from Roche …and GlaxoSmitKline (GSK)” the companies which make the drugs which were to be stockpiled. The guidance led to drug companies making billions of dollars from the stockpiling.
According to the Guardian, one of the main authors (Professor Fred Hayden) was being paid by Roche for lectures and consultancy work at the very time he was writing the guidance! And he had previously received payment from GSK.
What I find most worrying in all of this is that there are so many stories of the nastiness of drug companies in funding unethical practices, arranging ghost written articles for clinicians to sign on to (yes that is true! (3), etc. ... and nothing changes. Nothing.
Can this sort of corruption be stopped? Well there seems not much point in trying to stop individual clinical researchers and individual universities accepting payment and kickbacks from the drug companies. It’s been tried. It does not work. Policing it is just impossible and the climate and culture of clinical research would need a revolution. It will not happen.
The place to tackle this is in the incentive structures that the industry faces. So state ownership of companies is one option. Those who worry that investment in new drugs would dry up need to note that currently only 14% of the industry’s budgets goes on developing drugs (4). Another attractive option is one that the economist Joseph Stiglitz (5) has come up. He suggests that there be a massive multi-billion dollar prize set up by governments which would be won on the basis of drug inventions which did the most to improve health – instead of profits. I would suggest that rather than have governments pay for the prize as Stiglitz proposes, that this is funded by taxing the drug companies’ marketing budgets.
The majority of health problems in this world are in very poor countries where there are very limited monies available from governments and from people to pay for drugs. So the chances currently of Big Pharma seeking to develop drugs for developing countries is remote – the prospect of making profits is just not there. So the R&D on malaria drugs for example is inevitably tiny. And the extent to which the world gets on top of malaria is … tiny.
Currently the world’s poor struggle to pay for their drugs. When they succeed they often push themselves deeper into poverty. When they fail, they die.
There has to be a better way but it starts with outrage that this profit driven enterprise that could do so much good gets away with doing so little - except making big profits.
1. Lexchin J, Bero L, Djulbegovic B and Clark O, Pharmaceutical industry sponsorship and research outcome and quality: systematic review British Medical Journal 2003;326:1167-1170
2. Report condemns swine flu experts' ties to big pharma http://www.guardian.co.uk/business/2010/jun/04/swine-flu-experts-big-pharmaceutical
3. Medical editors push for ghostwriting crackdown http://www.nytimes.com/2009/09/18/business/18ghost.html
4. Angell M (2004) The Truth about the Drug Companies. New York: Random House.
5. J Stiglitz Scrooge and intellectual property rights http://www.bmj.com/cgi/content/full