Corruption in Global Health Care May Exceed $1 TRILLION
Reproduced from original article:
January 08, 2020
- Dishonesty and fraud in the health care system, including its academic and research communities, are significant barriers to the implementation of universal health coverage, yet this corruption is rarely if ever discussed, let alone addressed in any meaningful way
- The less transparent a health system is, the more corrupt it becomes. Weak adherence to the rule of law and few accountability mechanisms further invite corruption and, with it, health system performance, quality and efficiency plummet
- The amount of corruption found in any given system is dependent on three variables: Monopoly on the supply of a product or service, the level of discretion enjoyed by suppliers, and the supplier’s accountability to others
- Three factors governing the engagement in corrupt practices in the health care system are: being in a position of power; financial, peer and/or personal pressures; and cultural acceptance of corruption. In order for anticorruption measures to succeed, these three factors all need to be addressed
- Drug research is beset by an astoundingly high incidence rate of scientific misconduct, with 72% of retracted drug studies being retracted due to things like data falsification, fabrication, unethical conduct and plagiarism
Investigations assessing the prevalence of scientific fraud and/or its impact show the problem is widespread and serious, to the point of making most of “science-based” medicine a genuine joke. Conflict of interest is another pervasive problem that threatens the integrity and believability of most studies.
We’ve been repeatedly faced with study findings that are clearly tainted with industry bias. For example, a 2014 study1,2,3 funded by the American Beverage Association purported to have found that diet soda makes you lose more weight than drinking no soda at all.
Its findings blatantly contradicted a massive body of research demonstrating that artificial sweeteners disrupt your body’s metabolism and lead to greater weight gain than regular sugar.
Scientific Fraud Has Lethal Consequences
Another example is Dr. Don Poldermans’ fraudulent beta blocker study, which is suspected of having led to the deaths of as many as 800,000 Europeans. I wrote about this scandal in “Beta Blockers Killed 800,000 in 5 Years — Good Medicine or Mass Murder?”
The discredited paper had a profound influence as it served as the basis for establishing the use of beta blockers in noncardiac surgery patients as “standard of care.”4 Poldermans — who was fired for scientific misconduct in 2011 — was also the chairman of the committee that drafted that guideline.5
This case is a sobering example demonstrating the need for maintaining strict scientific integrity, and why the issue of conflicts of interest really needs to be more widely understood and addressed. Sadly, there are enough cases like this to fill several books.
Scientific misconduct can have a very real impact on your health, or someone you love, as doctors routinely use published research to implement or alter treatment protocols. As noted in a 2012 paper in the American Journal of Medicine:6
“Recent allegations of fraud committed by one of the most prolific researchers in perioperative medicine, Don Poldermans, have left many clinicians in a state of disbelief …
The effects of fraud in perioperative medicine are particularly caustic owing to a profound domino effect. Many investigators devoted their academic careers to following the footsteps of investigators such as Poldermans.
Similarly, funding agencies supported this line of enquiry, incurring significant cost and expense. Most importantly, hundreds of patients were exposed to treatments that may have been harmful in an effort to advance this research agenda …
Because research misconduct in perioperative medicine can be so damaging, we present strategies to prevent such events in the future. Without such reform, fraud in research may very well continue. The price for such misconduct is simply too great to pay.”
Conflicts of Interest Threaten Public Health
Disturbingly, conflicts of interest are present at all levels, including our most prestigious public health agencies, as discussed in my November 19, 2019, article, “CDC Petitioned to Stop Lying About Pharma Funds.”
While the U.S. Centers for Disease Control and Prevention has long fostered the perception of independence, claiming it does not accept funding from special interests,7 the agency has in fact made itself beholden to the drug industry by accepting millions in corporate donations through its government-chartered foundation, the CDC Foundation, which funnels those contributions to the CDC after deducting a fee.8
Several watchdog groups — including the U.S. Right to Know (USRTK), Public Citizen, Knowledge Ecology International, Liberty Coalition and the Project on Government Oversight — recently filed a petition,9 urging the CDC to cease making these false disclaimers.10
According to the petition,11 the CDC accepted $79.6 million from drug companies and commercial manufacturers between 2014 and 2018 alone. Since its inception in 1995, the CDC Foundation has accepted $161 million from private corporations.
The CDC is supposed to be a public health watchdog. It has tremendous credibility within the medical community, and part of this credibility hinges on the idea that it’s free of industry bias and conflicts of interest.
By accepting money from drug companies and vaccine makers, one has to wonder whether that money might be having an impact on the agency’s health recommendations, as investigations have repeatedly and consistently shown that funding plays an enormous role in decision-making and research outcomes.
Corruption in Global Health Is an Open Secret
In a December 7, 2019, article12 in The Lancet, Dr. Patricia Garcia — affiliate professor of global health at Cayetano Heredia University in Lima-Peru and a former minister of health13 — points out that “Corruption is embedded in health systems.”
In it, she argues that dishonesty and fraud in the health care system as a whole, including its academic and research communities, is “one of the most important barriers to implementing universal health coverage,” yet this corruption is rarely if ever discussed, let alone addressed in any meaningful way.
“Policy makers, researchers, and funders need to think about corruption as an important area of research in the same way we think about diseases. If we are really aiming to achieve the Sustainable Development Goals and ensure healthy lives for all, corruption in global health must no longer be an open secret,” Garcia writes.14
“Corruption is an open secret known around the world that is systemic and spreading. Over two-thirds of countries are considered endemically corrupt according to Transparency International … Corruption in the health sector is more dangerous than in any other sector because it is literally deadly …
It is estimated that, each year, corruption takes the lives of at least 140,000 children, worsens antimicrobial resistance, and undermines all of our efforts to control communicable and non-communicable diseases. Corruption is an ignored pandemic.”
Corruption Is a Cancer
In her paper, Garcia summarizes the history of corruption, how it got started and what allows it to spread. As a general commonsense rule, the less transparent a health system is, the more corrupt it becomes.
Weak adherence to the rule of law and few accountability mechanisms further invite corruption into its midst and, with it, health system performance, quality and efficiency plummet.
“It is estimated that the world spends more than US$7 trillion on health services, and that at least 10–25% of global spending is lost directly through corruption, representing hundreds of billions of dollars lost each year.
These billions lost to corruption exceed WHO’s estimations of the amount needed annually to fill the gap in assuring universal health coverage globally by 2030. However, the true cost of corruption for people is impossible to quantify because it can mean the difference between wellness and illness, and life and death,” Garcia writes.
3 Variables That Influence Corruption
Garcia cites research showing the amount of corruption found in any given system is dependent on three variables:
- Monopoly (M) on the supply of a product or service
- The level of discretion (D) enjoyed by suppliers
- The supplier’s accountability (A) to others
The amount of corruption (C) can thus be expressed as: C = M + D – A.
“This equation shows that the more concentrated a supply of a good or service is, the higher the discretionary power of those that control the supply is, and the lower their accountability to others is; therefore the amount of corruption will be higher,” Garcia writes.15
“Unfortunately, these are the characteristics of health systems. The complexity of the system, high public spending, market uncertainty, information asymmetry, and the presence of many actors (i.e., regulators, payers, providers, consumers and suppliers) interact at different levels, increasing susceptibility to corruption.”
Corruption also presents itself in a variety of ways. Bribery, extortion, theft, embezzlement, nepotism, the exertion of undue influence, favoritism, medical services done for financial gain rather than medical necessity, kickbacks, price inflation, manipulation of data and fraudulent billing are all examples given by Garcia.
Scientific fraud and misconduct also belong on this list. As detailed in “Why Your Doctor’s Advice May Be Fatally Flawed,” drug research is beset by an astoundingly high incidence rate of scientific misconduct, with 72% of retracted drug studies being retracted due to things like data falsification, fabrication, unethical conduct and plagiarism.16,17
Only 28% of retracted drug studies were retracted due to actual errors. Medical research also has a severe replication problem, with a vast majority of studies being impossible to replicate.
How Can We Control Corruption?
Corruption can be controlled, but it requires both good governance and a change in social norms, which can be difficult to achieve. Garcia explains:18
“Transparency International theorize that if institutions were strong, people wouldn’t even be tempted to participate in corruption.
The second group of theories, those concerning the way that people think, focus on the way people process rule breaking or an individual’s decision to engage in corruption. This process can be represented by the following equation:
Bp>Cpsy + pp (Ccrim + Csoc) + Cfav
In this equation, Bp represents the perceived benefit of an act of corruption, Cpsy the psychological costs, pp the perceived probability, Ccrim the criminal costs, Csoc the social costs to the individual, and Cfav the costs of doing the corrupt act.
From this equation, a corrupt act is more likely to happen if the perceived benefit (Bp) is higher than the sum of the psychological costs (or how the person will feel, which has to do with their personal values), the perceived probability of the criminal costs and social costs to the individual (which has to do with social norms), and the costs of doing the corrupt act (how easy or difficult it would be).
This theory highlights the importance of social norms. Experts agree that the two theories converge because social norms are assured through institutions. The challenge is how can strong institutions be created, and how can social norms be changed, to fight corruption?”
3 Factors That Govern Corrupt Practices
She also cites research suggesting the three factors governing the engagement in corrupt practices in the health care system are:
- Being in a position of power — Systems with poor oversight invite abuse of power
- Financial, peer and/or personal pressures
- Cultural acceptance of corruption
In order for anticorruption measures to succeed, these three factors all need to be addressed. Anticorruption measures suggested by experts include the following:19
|Providing incentives to reward good performance and sanctioning poor performance|
|Increasing transparency (active disclosure of how decisions are made and performance measures)|
|Community involvement and providing a platform for citizen feedback|
|Detection and enforcement by law enforcement|
|Enhancing financial management|
|Managing conflicts of interest|
|Improving policies and processes for investigations and the penalization of corrupt acts|
|Using technology platforms for active surveillance|
|The use of big data, data mining and pattern recognition to identify fraud or abuse profiles|
Still, Garcia notes that when searching the academic literature, she found “an absence of evidence on what works to reduce corruption in the health sector,” and there’s no data showing how well any of these measures actually work.
“There are already several authors who have highlighted open research questions that need to be addressed: we need to start working on them,” she says, adding: “We can start by designing and testing anti-corruption interventions for the health sector, for global health. We could start from the bottom up, taking small steps.
We need rigorous research methods to prove or disprove that a strategy works. Addressing and ending corruption will require the participation of researchers from several disciplines and multiple approaches, and the commitment of funders to supporting serious research. Corruption in global health should not continue as an open secret, it has to be confronted and brought to light.”
Death by Modern Medicine
For all the scientific breakthroughs we’ve been gifted with over the past century, modern medicine still leaves an awful lot to be desired, and the corruption permeating the whole system is one of the primary reasons for why it delivers such abysmal results.
In her book, “Death by Modern Medicine,”20 Dr. Carolyn Dean talks about how, for well over a century, the treatment of symptoms with drugs has dominated the definition of “health care.” It’s a deliberately schemed and manipulated paradigm that’s been packaged and sold through:
- The insurance industry’s (including Medicare’s and Medicaid’s) methodology for payment, which doesn’t recognize nutritional care or proven naturopathic approaches to health care
- Direct-to-consumer drug advertising
- Influencing physicians and other health care providers through gifts, honoraria for speaking engagements, and financial support for training programs, which is simply another form of advertising
- Intense lobbying by PhRMA — a leading biopharmaceutical trade group — and individual drug makers
The end result is a sickness industry that kills an enormous amount of people each year. In 2000, Dr. Barbara Starfield published a paper21 showing 225,000 Americans die each year from iatrogenic causes, meaning their death is caused by a physician’s activity, manner or therapy.
I read her article in the print in the July 2000 copy of JAMA and from it created the viral meme that took off, yet has rarely been attributed to me, that doctors were the third leading cause of death. Ironically, Starfield herself died from a medical error over 10 years later, when she suffered a lethal reaction to an inappropriate antiplatelet drug.
Remarkably, matters have not improved one whit since then. Research22 published in 2013 estimated that preventable hospital errors kill 210,000 Americans each year, and a 2016 study23 published in the BMJ estimated that medical errors kill 250,000 Americans each year.
That’s an annual increase of about 25,000 people from Starfield’s estimates, and these numbers may still be vastly underestimated, as deaths occurring at home or in nursing homes were not included.
Indeed, when they included deaths related to diagnostic errors, errors of omission and failure to follow guidelines, the number of preventable hospital deaths skyrocketed to 440,000 per year, which begins to hint at the true enormity of the problem.
Many Medical Procedures and Treatments Are Unnecessary
Overtesting and overtreatment are part of the problem and corruption plays a role here as well. Instead of dissuading patients from unnecessary or questionable interventions, the system rewards waste and incentivizes disease over health. According to a PLOS ONE report24 published in 2017, 20.6% of all medical care is unnecessary, including:
- 22.0% of prescription medications
- 24.9% of medical tests
- 11.1% of procedures
The top three most commonly cited reasons by doctors for overtreatment were:
- Fear of malpractice (84.7%)
- Patient pressure/request (59.0%)
- Difficulty accessing medical records (38.2%)
A majority of respondents (70.8%) also agreed that unnecessary procedures are more likely to be performed when the doctor profits from them, and “Most respondents believed that de-emphasizing fee-for-service physician compensation would reduce health care utilization and costs.” To learn which tests and interventions may do more harm than good, browse through the Choosing Wisely website.25
Exercising Good Judgment in an Era of Conflicting Interests
Ultimately, the take-home message here is that even if a drug or treatment is “backed by science,” this does not guarantee that it’s safe or effective. Likewise, if an alternative treatment has not been published in a medical journal, it does not mean it is unsafe or ineffective.
On the whole, modern medicine grossly undervalues and often flat out ignores the influence of diet and lifestyle factors such as sleep, exercise, time-restricted eating and exposures to the sun and nature (which are beneficial) and electromagnetic fields and toxins (which are harmful).
This is why it’s crucial to have a philosophical framework to assist you in evaluating health and medical recommendations. Consider the funding and look for evidence of replication and the building of consensus through time.
Anytime you’re trying to address a health issue, make full use of all the resources available to you, including your own sense of common sense and reason. Since it is well established that most drugs do absolutely nothing to treat the cause of disease, it would be prudent to exercise the precautionary principle when evaluating a new drug claim, as it is likely to be flawed, biased or worse.
Also, if you’re facing a health challenge, seeing a competent conventional physician to rule out a serious condition is just the beginning. It would be in your best interest to also identify a qualified natural health consultant, someone who really understands health at a foundational level, to make sure you’re addressing the root of your problem.
- 1 Obesity 2014; 22(6)
- 2 CNN May 27, 2014
- 3 NPR May 28, 2014
- 4 European Heart Journal (2009) 30, 2769–2812
- 5 Forbes November 23, 2011
- 6 American Journal of Medicine 2012 Oct;125(10):953-5
- 7 CDC.gov MMWR Disclosure
- 8, 11 USRTK Petition to the CDC, November 5, 2019 (PDF), Page 3
- 9 USRTK Petition to the CDC, November 5, 2019 (PDF)
- 10 USRTK November 5, 2019
- 12, 15 The Lancet December 7, 2019; 394(1014): 2119-2124
- 13 Department of Global Health, Patricia Garcia
- 14 The Lancet December 7, 2019; 394(1014): 2119-2124, Summary
- 16 Pharmacotherapy 2012; 32(7)
- 17 Newswise May 29, 2012
- 18 The Lancet December 7, 2019; 394(1014): 2119-2124, Corruption Control
- 19 The Lancet December 7, 2019; 394(1014): 2119-2124, Corruption Control, and Research in Anti-Corruption Measures in Global Health in the Real World
- 20 Amazon.com, Death by Modern Medicine by Dr. Carolyn Dean
- 21 JAMA July 26, 2000; 284(4): 483-485 (PDF)
- 22 Journal of Patient Safety September 2013: 9(3); 122-128
- 23 BMJ 2016;353:i2139
- 24 PLOS ONE 2017; 12(9): e0181970
- 25 Choosingwisely.org