[Ip-health] Fwd: [ESCR-Right-to-Health] Massive Corruption in the Pharmaceutical Sector

Rachel Kiddell-Monroe rachel.k.monroe at essentialmedicine.org
Wed Jun 15 13:04:25 PDT 2016

Rachel Kiddell-Monroe
Special Advisor
Universities Allied for Essential Medicines
"There is no such thing as the "voiceless". There are only the deliberately
silenced, and the preferably unheard." Arundhati Roy. Make your voice

"When you learn, teach. When you get, give." Maya Angelou

---------- Forwarded message ----------
From: Claudio Schuftan cschuftan at phmovement.org [ESCR-Right-to-Health] <
ESCR-Right-to-Health-noreply at yahoogroups.com>
Date: 10 June 2016 at 11:55
Subject: [ESCR-Right-to-Health] Massive Corruption in the Pharmaceutical
To: ESCR-Right-to-Health at yahoogroups.com

From: <english at other-news.info>

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

*By Roy Poses*,  Posted  by Yves Smith - Naked Capitalism *

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

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 anecdotic.

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

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

*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

*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

*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

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 Anecdotic 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 anecdotic, 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

**MD, Clinical Associate Professor of Medicine at Brown University, and the
President of FIRM – the Foundation for Integrity and Responsibility in
Medicine. Cross posted from the Health Care Renewal website*

Posted by: Claudio Schuftan <cschuftan at phmovement.org>
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