Sunday, 30 September 2018
Endemic corruption in healthcare – by Robin Daly
This week our founder discusses the recent news of the Memorial Sloan Kettering Cancer Centre’s Dr Jose Baselga, who resigned after failing to disclose industry ties…
A recent news item1 threw a spotlight on one of the ‘bright stars’ in medicine, Dr José Baselga1 exposing the considerable personal gains he has made ‘playing the field’. This is a snapshot of the ugly and unacceptable face of medicine. It is, of course, absolutely nothing new. What is new - and heartening - is that his behaviour is worthy of a news item, that at last we may be witnessing the dawning of an era in which it is no longer a normal, acceptable aspect of medical culture.
One of Dr Baselga’s most illustrious forbears, a man who really set the standard for self-interest and corruption, was Sir Richard Doll2. He is still remembered primarily for his bold stand against ‘big tobacco’ in firmly establishing the link between smoking and cancer. There’s no getting around it - this was a stunning achievement, considering the might of the forces marshalled against him by the tobacco corporations.
At this point, Doll was clearly the most dangerous man on the planet, when viewed from the standpoint of corporations knowingly engaged in destroying the environment and our health. The man had to be ‘neutralised’. Instead, they went one better than simply disarming him, they won him over to ‘the dark side’. Who better to whitewash dangerous practices than the most trusted scientist on the planet. ‘If Doll says it’s safe - it must be safe’.
Such was the normality of corruption in medicine that Doll made it to the grave at the ripe old age of 93, with his reputation and knighthood still nicely intact. It was only following his death that the scale of corruption and personal gain he had been involved in emerged. Undoubtedly public health has benefitted enormously from his work with smoking, but closer inspection of the trail of destruction resulting from his defence of toxic industries could arguably reveal that, on balance, he has done us all more harm than good.
One of the first to really lift the lid on the endemic corruption in healthcare, specifically around cancer, was Ralph Moss. His book ‘The Cancer Industry’3, a fearless exposé of the forces at work in cancer research, drug development and treatment, concluded with listings of all the key leaders of Memorial Sloane Kettering Cancer Centre, alongside all their other financial interests. What was immediately clear was that practically all of these posts were filled with people who were in charge of industries either directly causing or profiting from cancer. This was conflict of interest on an industrial scale.
This was all way back in the twentieth century, and it would be heartening to imagine that such things would never happen now. Tragically, however, Dr Baselga, the Chief Medical Officer at Memorial Sloan Kettering Cancer Centre in New York, has demonstrated all too clearly that it’s ‘business as usual’ when it comes to corruption. He seems to think nothing of overlooking the requirement to state the glaring conflicts of interest that any reasonable person would expect to make him completely ineligible to publish findings in respected medical journals, describing the omissions as ‘unintentional’. Apparently, he has ‘slipped up’ in this way more than 100 times since 2013. He also seems to think it’s of little consequence that he simultaneously oversees the clinical operations at one of the world’s foremost cancer centres, and sits on the boards of companies selling drugs and equipment to the hospital. In other areas of business such as finance, people get jailed for this type of behaviour, but in medicine it seems more like the very foundations on which the profession has been built.
And are the ‘respectable’ journals that publish this sales literature dressed up as science up in arms about all this? In fact, they are as unphased by the corruption as Baselga. They take it all in their stride, as of course the same source that has showered the doctor with ‘incentives’ also ‘motivates’ the journals to keep nicely in line with their marketing plans. ‘Transparency’ is wheeled out as the bullet-proof defence against the possibility of corruption ensuing from conflicts of interest. But even when doctors don’t ‘unintentionally’ overlook declaring such conflicts, the bare-faced gall of both the authors and the journals in brazenly advertising such unsupportable situations is breathtaking! It’s just all shockingly ‘normal’.
As for the corporations, recent ‘breakthrough’ judgements against Monsanto4 and Johnson & Johnson5 may seem, on the face of it, like victories for decency and the ‘man in the street’. And they are. But it’s worth keeping a realistic perspective on the fact that these corporations have, like Sir Richard Doll (and, incidentally, aided and abetted by him - Monsanto paid him a consultancy of $1500 a day in the 1980s to defend them), got away with it for decades, and the scale of profits involved utterly dwarfs any payouts they may now have to make. Millions of lives have been seriously affected by companies who knew exactly what they were doing, and no amount of money is going to restore lost lives.
And of course, this process will be going on with other profitable products right now, products that will also take their tragic toll for a few profitable decades more, before they can finally be ‘proven’ as dangerous to health. It’s simply all too normal to run business in this way: you buy the science you want, you confuse public debate about dangers, and you vigorously defend a product that harms us for as long as is possible.
Tragically, in healthcare, wherever you lift the bedcovers a little, you’ll find the same nasty infection at work, undermining the health of the public with greed and self-interest. The contrast between the healthy growth of corporate medicine and the simultaneous rapid decline in public health could hardly be starker. Pharmaceuticals have paid some of the largest fines in corporate history for their misdeeds. And although some of those misdeeds are crimes that have cost thousands their lives, curiously, a prison sentence seems to be eluded.
‘Deadly Medicines and Organised Crime’6 is the ‘text book’ of this field, detailing the true extent of this suppurating infection in medicine. Written by one of the world’s leading researchers*, each chapter catalogues yet more reasons for mistrusting the fruits of conventional medicine. Until doctors like Baselga are stripped of their position by their peers and made personally accountable for their actions, medicine will continue to fester, and we, the public, will continue to pay the price for the self-serving culture that calls itself healthcare.
At the time of writing, Peter Gøtzsche, author of Deadly Medicines and Organised Crime and an outspoken critic of corrupt practices in medicine has been ousted from directorship of the world-leading Nordic Cochrane Centre, a Centre he established in 1993 the same year as he co-founded The Cochrane Collaboration. The statement from the Centre for his ‘expulsion’ is the result of an increasing divergence of views, particularly with regard to the safety and effectiveness of psychiatric drugs and some vaccines7. Gøtzsche commented: “As most people know, much of my work is not very favourable to the financial interests of the pharmaceutical industry. Because of this Cochrane has faced pressure, criticism and complaints. My expulsion is one of the results of these campaigns.”