Leaders of big health care organizations clearly are interested in influencing public policy and government regulation in ways that favor their organizations, and often indirectly themselves. We expect such leaders and organizations to make their policy preferences known. However, increasingly we have found that they take shadowy routes to their policy goals.
We have frequently discussed how large health care organizations may use less than transparent methods to advocate for their policy and regulatory objectives. Their public relations departments may fund patient advocacy organizations and medical societies that support these objectives, so-called third-party strategies. They may fund distinguished professionals and academics as key opinion leaders for the same purposes. Often they do this in systematic ways so that there efforts amount to stealth advocacy or stealth lobbying campaigns.
Even more concerning is organizational support of the revolving door. Top organizational leaders may move into government policy and/or regulatory positions relevant to the organizations' goals. Government policy and regulatory leaders may know that lucrative positions in these organizations are available when they leave government. The revolving door is certainly a serious type of conflict of interest, and some deem it corrupt.
Big health care organizations have traditionally been non-partisan. While their leaders certainly may have political views, they used to keep them very quiet. Recently, especially in the US, we have seen evidence that some health care organizations have become partisan, albeit stealthily, throwing their support behind political candidates, parties and organizations that may support their policy and regulatory goals, even while they may also support positions that go against the health care and public health mission, or even may be frankly anti-democratic. In the US, organizations and their leaders now may support partisan aims with dark money, funds whose origin is disguised.
The Transparency International 2018 Corporate Political Engagement Index
A recent report by Transparency International was made public, with little fanfare, in late 2018 that was meant to throw a little light on corporate "engagement" in politics. It included some interesting information on a few multinartional pharmaceutical companies.
The report introduction stated:
For companies, corporate political engagement carries clear risks of bribery and corruption, conflicts of interest and reputational damage. Any interactions with the political process need careful management to avoid falling foul of anti-bribery and corruption legislation. The risks are increased by the fact that companies are vulnerable to mistakes or abuse by employees and third parties acting
on their behalf such as agents, advisers and consultant lobbyists.
Methods
The study on which the report was based concentrated on 104 large corporations that are active in the UK. These included the following large multinational pharmaceutical companies:
- AstraZeneca
- Eisai
- GlaxoSmithKline
- Johnson & Johnson
- Novartis
- Pfizer
- Roche
- Shire
The study was based on 20 questions divided in 5 areas.
Three areas were basically about transparency of and accountablity for political activities. These included
- Control Environment, including having transparent policies, methods for ensuring their enforcement, and oversight of same by the board of directors
- Responsible Lobbying, including adequate policies and transparency
- Transparency in Reporting
One was about the Revolving Door, and included whether the company has a "cooling-off period" for people going through the revolving door back to the company. However, it did not directly mention people going directly from leadership positions within the company to government.
One was about Political Contributions, and included whether the company bans them (perhaps the strongest question of the group.)
Each question in each area was scored from 2 for meeting expectations to 0 for failing to do so. Scores were normalized on a scale going from 100 (best) to 0 (worst), and and summarized in "bands" from A (83.3 - 100) down to F (0 - 16.6)
Results
For the three areas regarding transparency and accountablity the results per company were:
Control Environment
- AstraZeneca C
- Eisai C
- GlaxoSmithKline A
- Johnson & Johnson C
- Novartis F
- Pfizer C
- Roche E
- Shire C
Responsible Lobbying
- AstraZeneca E
- Eisai F
- GlaxoSmithKline B
- Johnson & Johnson E
- Novartis E
- Pfizer F
- Roche C
- Shire E
Transparency in Reporting
- AstraZeneca C
- Eisai C
- GlaxoSmithKline A
- Johnson & Johnson C
- Novartis C
- Pfizer C
- Roche C
- Shire C
For the Revolving Door
- AstraZeneca F
- Eisai F
- GlaxoSmithKline A
- Johnson & Johnson F
- Novartis D
- Pfizer F
- Roche E
- Shire F
For Political Contributions
- AstraZeneca F
- Eisai F
- GlaxoSmithKline B
- Johnson & Johnson C
- Novartis F
- Pfizer E
- Roche E
- Shire E
Summary and Discussion
Note that the pharmaceutical companies did not do too badly on the measures of transparency and accountablity, but except for GSK did quite badly on minimizing the revolving door, and again with the partial exception of GSK did very badly on avoiding political contributions.
This suggests that at least some big multinational pharmaceutical corporations that do business in the UK, but also in the US and many other developed countries, have worrisome attitudes towards and likely practices affecting their use of political influence.
The Revolving Door
The majority of companies did not show any real concern about the problem of the revolving door.
In the US, this problem seems to be getting worse. In particular under the Trump regime we see more instances of the incoming revolving door, that is, people moving directly from corporate leadership positions to government policy and regulatory positions in which they could potentially make decisions affecting the corporations from which they came. This is potentially a more serious problem than the outgoing door, yet it was not even discussed in the TI study.
We have repeatedly said, most recently a few days ago, ...
The revolving door is a species of conflict of interest. Worse, some experts have suggested that the revolving door is in fact corruption. As we noted here, the experts from the distinguished European anti-corruption group U4 wrote,
The literature makes clear that the revolving door process is a source of valuable political connections for private firms. But it generates corruption risks and has strong distortionary effects on the economy, especially when this power is concentrated within a few firms.
The ongoing parade of people transiting the revolving door from industry to the Trump regime once again suggests how the revolving door may enable certain of those with private vested interests to have disproportionate influence on how the government works. The country is increasingly being run by a cozy group of insiders with ties to both government and industry. This has been termed crony capitalism. The latest cohort of revolving door transits suggests that regulatory capture is likely to become much worse in the near future.
Corporate Partisanship, Political Contributions, and Dark Money
Given the increasing evidence that large corporations have become partisan in the US, it is particularly worrisome that at least the pharmaceutical corporations in the TI study have not taken a clear stand against making direct political contributions, or even in favor of making such contributions transparent.
Note that the TI report included the directive "do not make political contributions" among its "principles for responsible political engagement," adding:
Corporate political contributions should not be made on behalf of the company other than in exceptional circumstances where they provide general support for a genuine democratic process, with full transparency and full explanation.
On the other hand, as we said last year,...
Health care corporations recent and current funding of dark money groups seems to openly conflict with the corporations' promises of social responsibility. The slanting of these efforts towards one end of the political spectrum, one party, and now the current president suggest that these corporations may have partisan agendas.
Furthermore, the increasing knowledge of these corporate actions raises a big question: cui bono? who benefits?
It is obvious why a pharmaceutical company, for example, might want to defeat legislation that would lower its prices.
It is not obvious why it would want to consistenly support actions by one party, or by people at one end of the political spectrum, even if some such people seem "pro-business." After all, for years big corporations and their executives openly gave money to both US parties and their candidates, apparently in the belief that this would at least allow more visibility for the corporations' priorities no matter who was in power.
Now, the most obvious theory is that the new practice of secret donations only in right-wing, Republican, and/or pro-Trump directions, which must be orchestrated by top corporate management, and which are not disclosed to employees or smaller corporate shareholders, are likely made to support the top managers' self interest more than the broad priorities of the corporations and their various constituencies.
Thus not only is more investigation needed, at the very least, "public" corporations ought to fully disclose all donations made to outside groups with political agendas. This should be demanded by at least the corporations' employees and shareholders, but also by patients, health care professionals, and the public at large.
Meanwhile we are left with the suspicion that top health care corporate management is increasingly merging with the current administration in one giant corporatist entity which is not in the interests of health care, much less government by the people, of the people, and for the people.
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