Monday, December 31, 2012

Question for the New Year: Why is There Next to No Reaction to the Gilded Age of Health Care?

For the New Year, it is time to ponder- why is there still no organized outrage over the ongoing incompetent, uncaring, self-interested, conflicted, and often outright corrupt leadership of health care organizations we have documented incessantly on Health Care Renewal?

For example, just a few days ago, we documented a series of cases in which large US and multinational health care organizations settled cases alleging they deceptively marketed drugs so as to exaggerate their benefits and conceal their harms, bribed doctors and officials  outside of the US, gave kickbacks to US doctors, defrauded the US government, and monopolized markets for drugs, yet few leaders, and no top leaders of the companies involved suffered any negative consequences for authorizing, directing, or implementing these activities.  We have discussed many previous legal settlements involving similar bad behavior and similar impunity by the leaders of the organizations involved.   Again and again we have discussed how large organizations, often but not always drug, biotechnology and device companies, have manipulated the scientific literature (e.g., see examples of manipulation of clinical research, suppression of clinical research, and specific practices such as ghost-writing of apparently scholarly articles to benefit vested interests.)   We have discussed overblown compensation that made top managers and other organizational insiders rich without any rationale other than their ability to take such money off the top.  Yet in the US, despite ever rising costs presumably provoked by such leadership, without corresponding improvements in quality or access, there is still no organized movement for change.

The problems in US health care, however, seem to parallel problems in the larger society, and the world at large.  We have discussed parallels with bad leadership of financial firms, including the firms that drove us into the global financial collapse/ great recession, and to continuing income stagnation, recession, austerity, and decreasing opportunity for the poor and middle class around the world.

Yet parallel questions are just beginning to be asked about larger related political economic problems.  Recently, historian Brad DeLong attempted to address the question, "why next to no reaction to the second gilded age?"  (See this.).  Unfortunately, while he could demonstrate two powerful political movements that opposed the first Gilded Age, he was completely at a loss to explain why there has been no similar organized outrage about the second Gilded Age in which we exist today.  Despite incompetent, uncaring, self-interested, conflicted, and often outright corrupt leadership of many large corporations, non-profit organizations, and government agencies only a few voices, often bloggers like us, have objected.

Economist Mark Thoma then took up the question, but the best he could do was suggest that outrage has been moderated because of the existing, if frayed, social safety net, and because many people nonetheless saw the last two decades as a time of increasing economic opportunity. (See this. )   He did not address how this view may have been wrong, since the last two decades were a time of obviously worsening income inequality.

Yves Smith of Naked Capitalism finally offered some insight (see this) by noting the importance of "propaganda," corresponding, I think, to the widespread deceptive marketing and public relations, and the use of covertly paid key opinion leaders to further both that we frequently discuss.  Finally she suggested that people feel powerless because they see themselves as "atomized individuals," even though they many are currently being treated as interchangeable parts by the leaders of large organizations who can control the actions of large number of employees to further their self-interest.

There must be more reasons.  There ought to at least be some organized discussion of these reasons.  After that there needs to be some organized action to promote real reform.  I conclude the often miserable 2012 with a plea for those who are interested and concerned to come together to create real solutions.

ADDENDUM (1 January, 2013) - see comments by Dr Howard Brody on the Economism Scam blog.


Marilyn Mann said...

You should mention the BMJ open data campaign and the publication of Bad Pharma by Ben Goldacre. There is quite a lot of discussion going on in the UK and Europe on some of the issues you mention, especially with respect to publication bias and missing data, and other problems in the medical literature.


Judy B said...

I, too have often wondered why there is no (or very little) outrage either from patients or medical professionals on these issues. There seems to be an acceptance from both groups that this is the way things are and nothing can be done.

This is a complex issue and until ALL of us start to look more closely and demand change, everything will stay the same. I am grateful that you continue to reveal the shenanigans in your blog. I also hope that people will stop been so passive and start listening and reading!

Anonymous said...

Those who are in the best vantage to express outrage will have their necks slit or careers ended by the despots in the corner suites. There ain't no such thing as an independent medical staff, as required by the JC. The executives select the sham peer reviewers who quash any dissent with the ringing of the cash register or the abuse of patients by MR guided care and more.

Judy B said...

That should say "being so passive."