I’ve highlighted the fact that the pharmaceutical industry is responsible for nearly 20 percent of corporate crime in a number of previous articles.Here, I want to draw your attention to an excellent article1, 2 on the institutional corruption of pharmaceuticals, published in the Journal of Law, Medicine and Ethics. It’s well worth reading in its entirety if you have an interest in this topic.This term, “institutional corruption,” does not refer to any violation of existing rules or laws. Rather it refers to “a certain kind of influence, within an economy of influence, that has a certain effect,” as explained the Cambridge lecture above. As presented in the video, an activity is considered institutional corruption if it:
- Weakens the effectiveness of an institution, and/or
- Weakens public trust in that institutionThe lecture series was sponsored by the Edmond J. Safra Foundation Center for Ethics at Harvard, which also published the featured article on this topic, written by Donald W. Light, Joel Lexchin, and Jonathan J. Darrow. They write:3“Institutional corruption is a normative concept of growing importance that embodies the systemic dependencies and informal practices that distort an institution’s societal mission.An extensive range of studies and lawsuits already documents strategies by which pharmaceutical companies hide, ignore, or misrepresent evidence about new drugs; distort the medical literature; and misrepresent products to prescribing physicians.We focus on the consequences for patients: millions of adverse reactions. After defining institutional corruption, we focus on evidence that it lies behind the epidemic of harms and the paucity of benefits…If “corruption” is defined as an impairment of integrity or moral principle, then institutional corruption is an institution’s deviation from a baseline of integrity.”Lack of integrity is indeed different from outright violation of law, which is a punishable crime. Avoidance of “moral principle,” while not illegal per se, is still a very serious concern—if nothing else for the very real harm it produces. This is true in most situations, but it’s particularly heinous when it is the modus operandi of those who wield the greatest power over your health care.
The Three Levels of Institutional Corruption
The authors assert that, within the pharmaceutical industry, institutional corruption occurs at three different levels:
- Lobbying efforts and political contributions. This way, the pharmaceutical industry has influenced the US Congress to enact legislation that has severely undermined the stated mission and function of the Food and Drug Administration (FDA).
- Through the application of industry pressure, “Congress has underfunded FDA enforcement capacities since 1906, and turning to industry-paid “user fees” since 1992 has biased funding to limit the FDA’s ability to protect the public from serious adverse reactions to drugs that have few offsetting advantages,” according to the authors.
- Commercializing the role of doctors, undermining their position as “independent, trusted advisers to patients.”As stated in the featured article, the health care system is founded on the moral principle that a doctor, first, will do no harm. The principle of not harming the patient is explicit in the Hippocratic Oath,4 one of the oldest binding documents in history. Under that moral edict, the duty of any health care worker is, first and foremost, to treat illness using the best medical knowledge and science available, and to carefully assess the risks of harm.“The institutional corruption of health care consists of deviations from these principles,” the featured article states.