Wednesday, June 08, 2016

Transparency International Reports on Massive Corruption in the Pharmaceutical Sector - Media Hardly Notices

Health Care Corruption as a Taboo Topic

Transparency International (TI) defines corruption as

Abuse of entrusted power for private gain

In 2006, TI published a report on health care corruption, which asserted that corruption is widespread throughout the world, serious, and causes severe harm to patients and society.

the scale of corruption is vast in both rich and poor countries.


Corruption might mean the difference between life and death for those in need of urgent care. It is invariably the poor in society who are affected most by corruption because they often cannot afford bribes or private health care. But corruption in the richest parts of the world also has its costs.

The report did not get much attention.  Since then, health care corruption has been nearly a taboo topic in the US.  When health care corruption is discussed in English speaking developed countries, it is almost always in terms of a problem that affects benighted less developed countries.  On Health Care Renewal, we have repeatedly asserted that health care corruption is a big problem in all countries, including the US, but the topic remains anechoic.

Yet somehow, a substantial minority of US citizens, 43%, seemed to believe that corruption is an important problem in US health care, according to a TI survey published in 2013 (look here).  But that survey was largely ignored in the media and health care and medical scholarly literature in the developed world, and when it was discussed, it was again in terms of results in less developed countries.  Health Care Renewal was practically the only source of coverage in the US of the survey's results.

Transparency International's New Report on Corruption in the Pharmaceutical Sector

Now Transparency International (TI) has tried, and Health Care Reenewal will try again.  In June, 2016 Transparency International published a new report entittled

Corruption in the Pharmaceutical Sector

The report's executive summary states:

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.

In my humble opinion, the report is particularly significant in that it classifies as corrupt various kinds of activities that occur within the pharmaceutical sector (and also in other parts of health care) which are often discussed publicly as anything from standard operating procedure through unfortunate errors to unethical behavior. These include many activities which we have frequently discussed on Health Care Renewal. For example,

Manipulation of Clinical Research

We have frequently discussed how pharmaceutical companies, and biotechnology, medical device, and other health care companies and organizations, may manipulate clinical research to enhance the likelihood that is results will favor their products and marketing goals, even if the results are biased, inaccurate, could mislead physicians and patients, and ultimately harm patients.  The TI report included: 

As pharmaceutical companies rely on gaining market entry in order to recoup R&D costs, when there is a lack of oversight in clinical trial data publication a conflict of interest exists in which a pharmaceutical company may have an incentive to manipulate clinical trial data. When clinical trial data is manipulated medical literature can become biased with positive findings fabricated, positive findings exaggerated or negative results hidden. This can result in inadequate prescribing patterns because HCPs rely on clinical trial data to make decisions on which medicines to use to treat patients.

Suppression of Clinical Research

We have frequently discussed how health care organizations (as above) may outright suppress clinical research when the results fail to support their interests.  The TI report included:

Transparency and access to information through mandatory clinical trial registration, sanctions for not registering results or providing clinical trial information, and the publication of both positive and negative results are commonly discussed as helpful tools to curb corruption. With the European Medicines Agency (EMA) as a notable positive exception, public agencies and authorities do not require R&D-based pharmaceutical companies to make their raw data publicly available, making it impossible to verify whether the reported results are accurate. Based on laws and regulations clinical trial data is considered to be proprietary information, which allows pharmaceutical companies to conceal important data from the public domain.

Manipulation of the Dissemination of Clinical Research

We have frequently discussed how health care organizations may manipulate the dissemination of clinical research, through various forms of publications, presentations, courses, media summaries, etc, to favor their products and marketing goals, even if the results are misleading and could harm patients.  For example, a while back we discussed the problem of "ghost-written" articles appearing in scholarly journals. The TI report included:

The practice of ghostwriting is also a risk with clinical trials. Ghostwriting involves the writing of clinical trial publications by industry and then having a highly esteemed researcher pass these findings off as their own without disclosing their actual involvement with the authorship of the article. It is a common practice, particularly in industry led trials. Ghostwriting is done to increase the prestige and reputation of the findings, while simultaneously researchers are able to improve their reputation, which can lead to promotions. Clearly this practice can result in inaccurate results being published.

Deceptive Marketing

We have frequently discussed how marketing of pharmaceuticals (and nearly everything else in health care) may be deceptive, favoring companies' products and services, but again misleading health care professionals and patients, and ultimately risking patient harm.  In the extreme, pharmaceutical companies (and other health care organizations) may resort to bribes or kickbacks.  The TI report included:

There are several methods for a corrupt pharmaceutical company to unethically market its medicines. At its most simple a pharmaceutical company can bribe a HCP directly with payments so its medicines are more likely to be prescribed. More abstrusely individuals may include a pharmaceutical company’s medicine on the national list that is reimbursed by public funds, in return for an indirect bribe by being sent to inappropriate holiday destinations for lavish conferences.

Corrupt marketing practices also include pharmaceutical companies providing misleading information regarding the safety and efficacy of a medicine to influence doctors’ prescribing habits and encouraging off-label, unlicensed use to increase sales.

Other Topics

Finally, the report mentions such issues as the revolving door, regulatory capture, etc, etc, etc

A Striking, and Strikingly Anechoic Report

Again, while the report summarizes information that is likely familiar to most Health Care Renewal readers, what is striking is that it describes manipulation of clinical research, suppression of clinical research, manipulation of dissemination of clinical research, and deceptive marketing as corruption.  That is a sentiment rarely heard in the US, and one that appears nearly taboo.  

Demonstrating the strength of the taboo, this striking report has gotten almost no attention in the media or scholarly medical and health care literature in the developed English-speaking countries.  Let me note the important exceptions, however.

I learned of the report from a brief news item from the BMJ, the prestigious UK journal that seems most at the forefront of championing the integrity of medical and health care research.(1)  The only substantial news article I could find on the report was also from the UK, in the Independent.  Its sub-title is worth repeating:

Transparency International says corruption is making a few rich and wrecking the health of some of the world's poorest people

Also, there were brief articles in Reuters, and in (web-only) FiercePharma.  That is about it so far.

The report itself suggests why it has been so anechoic, just like nearly every other attempt to expose health care corruption to public discussion.  Essentially, there is so much money to be made through pharmaceutical (and by implication, other health care corruption) that the corrupt have the money, power, and resources to protect their wealth accumulation by keeping it obscure.  In the TI Report itself,

However, strong control over key processes combined with huge resources and big profits to be made make the pharmaceutical industry particularly vulnerable to corruption. Pharmaceutical companies have the opportunity to use their influence and resources to exploit weak governance structures and divert policy and institutions away from public health objectives and towards their own profit maximising interests.

Keep in mind that the money made from corruption does not just go to innocent peoples' retirement funds that are invested in pharmaceutical stocks.  It predominantly goes to top corporate executives and managers, and their cronies who preside over the corrupt practices.

I might as well repeat myself once again.  As I wrote in 2015,

If we are not willing to even talk about health care corruption, how will we ever challenge it? 

So to repeat an ending to one of my previous posts on health care corruption....  if we really want to reform health care, in the little time we may have before our health care bubble bursts, we will need to take strong action against health care corruption.  Such action will really disturb the insiders within large health care organizations who have gotten rich from their organizations' misbehavior, and thus taking such action will require some courage.  Yet such action cannot begin until we acknowledge and freely discuss the problem.  The first step against health care corruption is to be able to say or write the words, health care corruption.


1.  Torjesen I.  Group calls for more to be done to tackle corruption in the pharmaceutical industry. BMJ 2016;353:i3099. Link here.


Asuransi Kesehatan said...

not only in the 3rd word, corruption in health care is a serious problem. need strong political will to rid of this phenomena.

Judy B said...

Indeed, we need to say "health care corruption" over and over and very loudly!
It is disgusting that the media is so deliberately oblivious to the corruption but not surprising. Much of their income comes from pharma advertising...

Benedict@Large said...

This is hardly surprising. When the chase for extreme profits on Wall Street began back in the latter 1970s, it was the cutting edge pharmaceuticals (Genentech, Cetus, etc.) that led the way with P/E ratios of 30 and above being standard fare. It's now to the point that these profit levels are a requirement of pharmaceutical management, and corruption seems to be the easiest way to achieve them.

Afraid said...

This will take much more.than courage. Standing against corruption will ruin a lot.of good people first. Things will naturally get worse before they get better.

Few will stand when their livelihood and health are at risk, and can you blame them?

The whole system is way out.of control. We citizens don't trust our most precious institutions anymore. America is in a crisis of confidence.

Unknown said...

These topics and more were published in Chapter 16 of the International Handbook on whistleblower research (2014).
By necessary implication you cannot have a stable economy where so many sectors (including but not limited to) pharmaceutical industry are affected by multiple activities that purportedly present a benign picture of an industry that is really sick.
The pharmaceutical industry has and continues to attract attention for bribery, corruption, fraud and false claims.
Governments that turn their backs on such conduct do nothing towards improving health or corruption perception indexes.
I agree...more needs to be done.
I present a globally consistent False Claims Act ( qui tam) to address this and other issues facing the globe.

Meryl Nass, M.D. said...

Look around. Are any major areas of society free from corruption?

Public Education. Policing. The judiciary. Local, state, federal government. The AP, television. The military.

Isn't our fight against the takeover of our public life by corrupt influences in all sectors?

Given the obvious corruption evidenced in primary elections this year, people get it. Can we drop the PC conversations and start talking about what is really happening to life as we knew it, and why. Can corruption stop being a "4 letter word"?

Anonymous said...

I have been a pharmacist for 40 years, and what Big Pharma is doing today is nothing but fraud to get people to take more drugs. They want you to be dependent on them to live longer. But is is nothing but a fraud to think you will live a quality life longer. Drugs have two actions , the one you desire and the one you do not want. If you think oral medications will allow you to live longer your being lead done a road of illusion. The extra years you live will not be quality years as the side effects of the drugs will require more drugs to offset those side effects. If you do not change anything in your lifestyle except take drugs, you will be sadly lead down an illusional road.

Anonymous said...

Media has changed. Competition now forces them to make money to survive, so they are no longer benevolent organizations with a modicum of social justice. We can no longer count on them. But their replacement is the internat, places like health care renewal. Not yet very effective, but gaining influence. HCR needs more effort, maybe a wider audience. Twitter and the like could help.

Roy M. Poses MD said...

Anonymous of June 19

Thanks for the kind words.

HCR operates with volunteer bloggers. I am not sure we can make much more effort on our own. We sorely need more active bloggers, other bloggers/ writers/ advocates to chime in. If you us to make more effort, you may want to consider contributing to FIRM, the non-profit that tries to support us, but so far has had little outside financial support. See the sidebar for details, or email me at rposes at firmfound dot org. Also, if anyone knows of any foundations - the type that has money to donate - who might conceivably be interest in us, please let them know of us, or let me know of them.