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Title: Corporate Control of Public Health: Case Studies and Call to Action


1
Corporate Control of Public HealthCase Studies
and Call to Action
  • Martin Donohoe

2
Am I Stoned?
  • A 1999 Utah anti-drug pamphlet warns
  • Danger signs that your child may be smoking
    marijuana include excessive preoccupation with
    social causes, race relations, and environmental
    issues

3
Corporations
  • The only social responsibility of business is
    to increase its profits.
  • - Milton Friedman

4
Corporations
  • Corporations have no moral conscience. They
    are designed by law, to be concerned only for
    their stockholders, and not, say, what are
    sometimes called their stakeholders, like the
    community or the work force
  • -Noam Chomsky

5
Outline
  • Corporate Domination of World Economy
  • Corporate Taxation
  • Corporate Crime
  • Corporations and Education
  • Corporations and the Media

6
Outline
  • International Non-Cooperation and Isolationism
  • Case Studies
  • Solutions
  • Discussion

7
Corporations Dominate the Global Economy
  • Almost 6 million corporations
  • 90 of transnational corporations headquartered
    in Northern Hemisphere
  • 500 companies control 70 of world trade

8
Corporations Dominate the Global Economy
  • 53 of the worlds 100 largest economies are
    private corporations 47 are countries
  • Wal-Mart is larger than Israel and Greece

9
The Stock Market
  • The top 1 of Americans owns 51 of all stocks,
    bonds, and mutual fund assets
  • Consequences of Differential Stock Ownership
  • Corporations are answerable to their shareholders
  • Governments are answerable (at least in theory)
    to their citizens (either through elections or
    revolutions)

10
Corporations
  • Internalize profits
  • Externalize health and environmental costs

11
Corporate Taxation
  • Corporations shouldered over 30 of the nations
    tax burden in 1950 vs. 8 today
  • Nearly 1/3 of all large U.S. corporations pay no
    annual tax

12
Corporate Taxation
  • Big business claims that U.S. corporations pay
    the highest corporate taxes in the world (35)
  • FALSE The rate actually paid, after foreign
    governments get their cuts, money sent to foreign
    subsidiaries, loopholes, etc. 2.3 (U.S.
    Treasury Department)

13
Corporate Taxation
  • 2004 Bush administration offered temporary tax
    holiday on foreign earnings
  • 300 billion in profit repatriated
  • 92 went to dividend payouts, stock buybacks, and
    corporate coffers
  • Only 8 went to R and D, new factories, and hiring

14
Reasons for Inadequate Corporate Taxation
  • Corporate tax breaks/loopholes
  • Corporate welfare
  • Cheating and under-payment common
  • Offshore tax havens shelter capital

15
Ugland House, Cayman Islands18,000 Corporations
Registered Here
16
White Collar (Corporate) Crime vs. Blue
Collar (Street) Crime
  • Each year in America, we lose
  • 3.8 billion to burglary and robbery
  • Hundreds of billions to trillions of dollars to
    white collar crime

17
Why So Much Corporate Crime
  • Fines meager, often considered a cost of doing
    business
  • Corporate crime under-prosecuted, prosecutors
    under-funded
  • Confidential legal settlements keep important
    public health and safety information secret
  • May delay governmental intervention, cause
    unnecessary morbidity and mortality

18
Corporate Crime
  • Companies mandating forced arbitration
  • SCOTUS allows corporate binding arbitration
    contracts, limiting class action lawsuits (ATT
    v. Concepcion, 2011)
  • Arbitration Fairness Act would counteract ruling

19
Consequences of Corporatization
  • Increasing industry consolidation/mergers
  • Inflation
  • Rising unemployment

20
Consequences of Corporatization
  • Rise of the permatemp
  • Expatriation of jobs
  • Overseas factories often lack adequate
    occupational health and safety and environmental
    standards
  • Decline in labor union membership

21
Exorbitant CEO Pay
  • CEO salaries up 500 since 1980
  • The average CEO makes 350-400X the salary of the
    average U.S. worker (1960 - 41X)
  • Mexico 451
  • Britain 251
  • Japan 101

22
  • Corporate Involvement in Education

23
Would You Sign a Petition to Ban Dihydrogen
Monoxide?
  • 1. It can cause excessive sweating and
    vomiting2. It is a major component in acid
    rain3. It can cause severe burns in its gaseous
    state4. It can kill you if accidentally
    inhaled5. It contributes to erosion6. It
    decreases effectiveness of automobile brakes7.
    It has been found in tumors of terminal cancer
    patients

24
Geographic/Scientific Ignorance, Pseudoscience
  • Percent of US teens unable to locate the
    following on a map
  • United States 11
  • Pacific Ocean 29
  • Japan 58

25
Pseudoscientific Beliefs
  • Percentage of Americans who believe at least to
    some degree in these phenomena
  • 1997 1976
  • Astrology 37 17
  • UFOs 30 24
  • Reincarnation 25 9
  • Fortune-Telling 14 4

26
Ignorance/Pseudoscientific Beliefs
  • Half of US citizens do not believe in evolution
    and do believe that humans and dinosaurs
    coexisted (2007)
  • 40 think scientists still generally disagree
    about evolution

27
Pseudoscientific Beliefs
  • 37 believe places can be haunted (2007)
  • 25 believe in UFOs (2007)
  • 24 believe in astrology (2009)
  • 16 believe that people with the evil eye can
    cast curses or harmful spells
  • 14 have consulted a psychic or fortune teller
    (2009

28
Ignorance/Pseudoscientific Beliefs
  • 22 of Americans dont know whether an atomic
    bomb has ever been dropped (2000)
  • 20 of Americans dont know the earth revolves
    around the sun (1999)
  • 18 believe in Bigfoot and the Loch Ness Monster
    (2007)
  • 8 of men / 18 of women believe in astrology and
    fortune tellers (2007)

29
Public Education in Disarray
  • U.S. Schools ranked lowest among western nations
  • Inadequate funding, decaying infrastructure
  • National HS graduation rate stagnant at 65-70
  • College tuition costs rising

30
Nations Schoolchildren Call For Cuts in
Math/Science Funding
31
Television and the Media
  • The average American youth spends 900 hrs/yr in
    school, 1,500 hrs/yr watching TV
  • By age 65, the average American will have spent 9
    yrs watching TV

32
Corporate PR Tactics
  • Advertising
  • Astroturf - artificially-created grassroots
    coalitions
  • Corporate front groups

33
Corporate PR tactics
  • Invoke poor people as beneficiaries
  • Characterize opposition as technophobic,
    anti-science, and against progress
  • Portray their products as environmentally
    beneficial despite evidence to the contrary

34
Greenwash
  • Public relations / ad campaigns
  • BP invests 100 million annually in clean energy
    amt. it spends annually to market itself as
    moving Beyond Petroleum

35
Sponsored Environmental Education Materials
(Examples)
  • International Paper
  • -Clearcutting promotes growth of trees that
    require full sunlight and allows efficient site
    preparation for the next crop
  • Exxons Energy Cube
  • -Gasoline is simply solar power hidden in
    decayed matter
  • -Offshore drilling creates reefs for fish

36
Academics/Professional Organizations Affected
  • Increasing corporatization of academia
  • ?Private commercial funding of university
    research
  • Secrecy/Gag Clauses
  • For-profit colleges growing, marked by
    corruption, high interest rates on loans to the
    un- and under-qualified

37
The Media
  • 5 corporations control majority of US media (down
    from 50 in 1983)
  • Extensive corporate-media links

38
Global Warming Controversial?
  • Of 928 articles in peer-reviewed scientific
    journals, none were in doubt as to the existence
    or cause of global warming
  • Of 636 articles in the popular press (NY Times,
    Washington Post, LA Times, WSJ), 53 expressed
    doubt as to the existence (and primary cause) of
    global warming
  • Science 20043061686-7
  • (Study covers 1993-2003)

39
Lobbying
  • Over 15,000 full-time lobbyists
  • Estimates of return on lobbying range from 28 to
    100 for every 1 spent

40
Lobbying
  • Lobbying groups spent 3.5 billion in 2010
    (federal lobbying, a record)
  • Financial sector spent over 1.7 billion on
    campaign contributions for federal elections from
    1998-2008
  • All single issue ideological groups combined
    (e.g., pro-choice, anti-abortion, feminist and
    consumer organizations, senior citizens, etc.)
    76 million
  • SCOTUS Citizens United decision has opened the
    floodgates for unlimited corporate contributions

41
The Decline of Democracy
  • True democracy demands an informed citizenry
    (education), freedom of the press (media), and
    involvement (will, time, money)
  • Democracy is critical to the success of public
    health

42
Corporations and International Agreements
  • Corporations attempt to influence writing and
    acceptance/rejection of international agreements
  • Through misinformation, lobbyists, revolving door
    between industry and government
  • Large behind the scenes role

43
International Non-Cooperation/Isolationism
  • Failure to sign or approve
  • Kyoto Protocol on Climate Change
  • International Covenant on Economic, Social, and
    Cultural Rights
  • Convention on the Prohibition of Anti-Personnel
    Land Mines

44
International Non-Cooperation/Isolationism
  • Failure to sign or approve
  • Treaty to ban cluster bombs Convention on the
    Rights of the Child
  • Convention on the Elimination of Discrimination
    Against Women

45
International Non-Cooperation/Isolationism
  • Failure to sign or approve
  • WHO Code of Conduct for Marketing Breast Milk
    Substitutes
  • Convention for the Suppression of Traffic in
    Persons
  • The Stockholm Convention on Persistent Organic
    Pollutants

46
Worldwide Health and Social Justice Can Aid Help?
  • US ranks 21st in the world in foreign aid as a
    percentage of GDP (0.7)
  • Foreign Aid
  • 1/3 military
  • 1/3 economic
  • 1/3 food and development

47
  • Case Studies

48
Bringing Bad Things to Life
  • The alliance between GE Medical Systems and
    NY-Presbyterian Hospital
  • Martin Donohoe

49
The Partners
  • NY-Presbyterian Hospital
  • one of the largest academic health care
    institutions in the U.S.
  • GE Medical Systems (now GE HealthCare)
  • Subsidiary of General Electric
  • 9 billion annual revenues

50
The Agreement (2003)
  • 10-year, 500 million agreement requires NYP to
    purchase products and services from GEMS in
    exchange for purported discounts on medical
    supplies and the promise of enhanced
    technological standardization and simplification

51
General Electric
  • Ranked by Forbes as worlds largest company
    (based on equal weighting of sales, profits,
    assets, and market value)
  • 2009 revenues of 156 billion
  • Close to the GDP of about 2/3 of U.N. member
    states
  • 2010 net after-tax profits of 14.2 billion
  • 5.1 billion in U.S.

52
General Electric
  • Makes household appliances, lighting, and medical
    equipment
  • Plastics division, which produced bisphenol A,
    spun off in 2008
  • Has built 91 nuclear power plants in 11 countries
    (including Japans troubled Fukushima Daishii
    reactors)
  • Produces jet engines and military hardware

53
General Electric
  • Charles Wilson (CEO of GE pre- and post-WW II
    helped oversee U.S. military production during WW
    II)
  • The revulsion against warwill be an almost
    insuperable obstacle for us to overcome. For that
    reason, I am convinced that we must begin now to
    set the machinery in motion for a permanent
    wartime economy.

54
General Electric
  • Operates coal-burning power plants
  • Major releasers of toxic mercury
  • Operates a large financial services group
  • Lending accounts for gt 30 of revenue, vs. lt 6
    of revenue from consumer appliances
  • Responsible for just over 50 of profit in recent
    years
  • Owns a multi-billion dollar media empire
  • Including NBC (49, Comcast 51), Telemundo,
    and Universal Studios

55
GEs History
  • Conducted unethical human subject experiments on
    prisoners, involving testicular irradiation, from
    1940s to 1960s
  • Intentionally-released excessive radiation from
    its Hanford, WA nuclear reactor in the 1980s, to
    determine how far it would travel
  • May have contributed to increased thyroid
    cancers, hypothyroidism, and spontaneous
    abortions in Downwinders

56
GEs Record
  • Sued radiologist who brought to light dangers of
    GEs contrast agent, Omniscan
  • Causes nephrogenic systemic fibrosis (FDA black
    box warning)
  • Ordered to pay 11.4 million to Bracco
    Diagnositcs for falsely/misleadingly claiming
    that its x-ray contrast agent Visipaque was
    superior to BDs Isovue

57
GEs Record
  • Americas largest corporate polluter
  • 116 Superfund sites nationwide
  • Approximately 13 in NY

58
GEs Record
  • Between 1947 and 1977, two of its capacitor
    manufacturing plants dumped 1.3 million pounds of
    PCBs into the Hudson River
  • Probable human carcinogens with adverse effects
    on liver, kidney, nervous system, and
    reproductive organs (EPA)
  • 200 mi of Hudson Superfund site

59
GEs Record
  • Has spent millions to avoid Hudson cleanup and to
    weaken or eliminate Superfund Law
  • Contributes to corporate front groups
  • Promulgate an anti-scientific and
    pseudo-scientific agenda
  • Conduct media disinformation campaigns in an
    attempt to weaken health and environmental
    regulations

60
GEs Record
  • Tremendous influence of environmental, energy,
    and health policy
  • Spent over 25 million on federal government
    lobbying in 2009 (2 after Exxon Mobil)
  • 200 million over last decade
  • Many members of board of directors have
    government ties others have insurance and
    pharmaceutical industry ties

61
GE CEO Jeffrey Immelt
  • 2009 compensation 5.5 million
  • Named Worlds Best CEO in 3 separate Barrons
    polls
  • 2006 - 2011 - On Board of NY Federal Reserve Bank

62
GE CEO Jeffrey Immelt
  • 2008 Named one of the 100 Most Influential
    People in the World by TIME Magazine
  • 2009 - Appointed by President Obama to his
    Economic Recovery Board
  • GE then became eligible, via a loophole, for ¼ of
    the 340 billion Temporary Liquidity Guarantee
    Program (debt support)

63
GE CEO Jeffrey Immelt
  • 2011 - Appointed by Obama as Chair of his outside
    panel of Economic Advisors and of his Council on
    Jobs and Competitiveness
  • On the board of directors of The Robin Hood
    Foundation!

64
GEs Record
  • Has eliminated 150,000 jobs in last 15 years
  • While receiving billions in federal contracts and
    millions in state and local subsidies
  • One of nations top out-sourcers of jobs
  • 1/5 of U.S. workforce eliminated since 2002
    (while overseas workforce increased)

65
GEs Record
  • Executive pension plan far more generous than for
    other employees
  • Continues to shift health care costs onto
    workers, despite growing profits

66
GEs Record
  • Cited by Human Rights Watch for systematic
    workers rights violations in the U.S. and
    abroad
  • 858 OSHA workplace citations from 1990-2001
  • Investments include for-profit prison enterprises

67
GEs Record
  • GE has sponsored PGA Masters Tournament at
    Augusta National Golf Club
  • Club excludes women
  • CEO Immelt a member

68
GEs Record
  • Topped 2002 Project on Government Oversights
    list of repeat offenders for defrauding U.S.
    taxpayers
  • Paid more than 982 million in fines, judgments,
    and out-of-court settlements between 1990 and
    2002
  • Financial services division fined 100 million
    for unfair debt collection practices and
    bankruptcy court malfeasance

69
GE and Corporate Taxes
  • GE topped the list of corporate tax break
    recipients from 2001-2003
  • 9.5 billion in tax breaks
  • Claimed tax benefits of 3.5 billion in 2010
    (4.1 billion tax benefits on 26 billion in
    American profits between 2006 and 2010)
  • Under investigation for tax evasion in Brazil
  • Tax department has almost 1,000 employees (known
    as the worlds best tax law firm)

70
GEs Record
  • In 1990s, Pentagons Defense Contract Management
    Agency created special investigations office
    specifically for GE
  • Nevertheless, company has been awarded
    increasingly costly reconstruction contracts in
    Iraq and Afghanistan

71
GEs Record
  • The Patient Channel
  • Shown in hospital rooms throughout country
  • Advertising vehicle for drug companies
  • Criticized by JCAHO for manipulative marketing
    practices

72
GEs Record
  • Produces an electronic medical record, Centricity
    EMR
  • Is hoping to receive some of the 19 billion
    earmarked for health care information technology
    in the current economic stimulus package.

73
GEs Record
  • Named Americas Most Admired Company by Forbes
  • Named one of the Worlds Most Respected
    Companies in polls conducted by Barrons and The
    Financial Times

74
Concerns About the Agreement
  • Provides GE with financial incentives to promote
    high technology purchases
  • Hospital prohibited from purchasing more
    effective equipment from other companies

75
Concerns About the Agreement
  • Augments trend in academic medical centers to
    promote the use of expensive, high-technology
    care at expense of preventive care and public
    health measures
  • Highly reimbursable
  • Services may be redundant in certain locations

76
Concerns About the Agreement
  • Occurs at time 51 million Americans uninsured
  • Academic medical centers promoting luxury primary
    care clinics and seeking wealthy overseas
    patients while cutting back on services to the
    un- and under-insured

77
Concerns About the Agreement
  • Academic medical centers becoming increasingly
    corporatized
  • Research exclusivity contracts
  • Secrecy
  • gag clauses
  • skewing of research agenda

78
Concerns About the Agreement
  • I contacted the CEO of New York Presbyterian
    Hospital and the head of the Ethics Department to
    obtain more information re the agreement and the
    nature of the discussion preceding the agreement
  • No Response

79
Concerns About the Agreement
  • Patients with developmental anomalies and cancers
    caused by GEs pollution diagnosed with GE
    scanners and treated with GE-manufactured
    therapeutic devices, increasing GEs profit

80
  • A macabre twist on cradle to grave care

81
Solutions
  • NY-P should cancel agreement
  • Health care providers and organizations should
    condemn this unholy alliance
  • Medical and ethical organizations should develop
    standards regarding future agreements

82
Confronting Pseudoscience and Threats from a
Corporate Front GroupThe American Council on
Science and Health
83
Background
  • 2007 Essay describing health and environmental
    consequences of global warming for Medscape
  • Described ACSH as a corporate front group and
    criticized its selection of author Michael
    Crichton as recipient of its 2005 Sound Science
    Medal

84
ACSH and Global Warming
  • Leader referred to belief that burning fossil
    fuels has caused global warming as pseudoscience
  • Criticized environmental scientists as
    doomsayers and fearmongers

85
ACSH Response
  • Threatened litigation against Medscape
  • Medscape briefly pulled article, then published
    with comments removed, then republished with
    additional material
  • ?Loss of potential readership?

86
Dr Elizabeth WhelanPresident and co-founder
  • Early writing career included
  • Freelance writing assignment for Pfizer
    criticizing the FDA
  • Consumer magazine pieces
  • Books include Panic in the Pantry and Toxic
    Terror
  • Whelans 2003 salary 326,612

87
Dr Gilbert RossMedical/Executive Director
  • Spent 1996 in federal prison after being
    sentenced to 46 months for
  • Medicaid fraud
  • Perjury
  • Obstruction of justice
  • Not mentioned on his bio on ACSH website

88
ACSHDr Gilbert Ross Career
  • Barred by the DHHS for 10 years from
    participating in either Medicare or Medicaid
  • Now in charge of all scientific projects,
    publications, and personnel issues involving
    scientific staff at ACHS

89
ACSH
  • ACHS Board of Directors includes anti-regulatory
    Individuals (2001 Survey)
  • George Lundberg, former editor of JAMA, current
    editor of Medscape, on board of advisors
  • Funding from right wing foundations, corporations
  • Accepted money to write and disseminate
    pro-industry studies

90
Corporate Front Groups
  • Promote corporate agendas
  • Strong financial and advisory links with
    corporations
  • Disseminate misinformation/lies under guise of
    science
  • Promote pro-business, conservative ideology

91
ACSHPseudoscience and Misinformation
  • Attacked the precautionary principle
  • anti-science, elitist, and theology
  • Minimized the effects of environmental tobacco
    smoke (ETS) on human health
  • 40,000 deaths/yr in U.S.

92
ACSHPseudoscience and Misinformation
  • Denied many of the adverse neurological effects
    of lead exposure
  • Denied endocrine-disrupting effects of PCBs
  • Claimed court ordered-cleanup of Hudson River by
    GE based on false claims of PCBs causing cancer
  • Claimed uncertainty regarding effects of
    agricultural antibiotics on food-borne,
    antibiotic-resistant human infections

93
ACSHPseudoscience and Misinformation
  • Called warnings regarding tuna consumption by
    pregnant women unfounded health scare
  • Critiqued health concerns re trans fatty acids
  • There is no such thing as junk food
  • There is insufficient evidence of a relationship
    between diet and any disease.

94
ACSHPseudoscience and Misinformation
  • Claimed irradiated food is safe, wholesome and
    nutritious and no radioactive isotopes are
    involved
  • Denied link between dioxins and pesticides and
    adverse health effects
  • Supported use of human volunteers in pesticide
    toxicity studies

95
Phony Health Scares
  • Flame retardant traces found in blood and breast
    milk
  • Diesel exhaust fumes from school busses
  • Arsenic in drinking water
  • Phthalates in medical devices and childrens toys

96
ACSH Attacks on Scientists and the Scientific
Enterprise
  • Threat of litigation against Medscape
    antithetical to the rules of science
  • requires the free exchange of information and
    opinion in pursuit of the truth

97
ACSH Attacks on Scientists and the Scientific
Enterprise
  • ad hominem attacks
  • environmentalists toxic terrorists
  • Whelan criticized Dr. Barry Levy and
    citizen-activist Erin Brockovich

98
Implications of Attacks on Science and Scientists
  • ACSH has broad media presence
  • Web site attracts large numbers of individuals
  • 100,000 hits per month for 2005
  • Dr. Whelan has been featured on NBCs Today Show,
    CNN Live, and CNBCs Business Insiders

99
Implications of Attacks on Science and Scientists
  • Editorials by Whelan and Ross have appeared in
    the New York Times and Wall Street Journal
  • Publications in Medscape, other journals

100
Implications of Attacks on Science and Scientists
  • Mislead public
  • May cause alterations in lifestyle and/or
    purchasing habits
  • Adverse health consequences
  • Threats of litigation distract, intimidate, and
    deplete the scientific, legal, and financial
    resources of individuals and groups committed to
    public health

101
Implications of Attacks on Science and Scientists
  • Faulty pronouncements influence elected officials
  • Threats of litigation divert the valuable time of
    health care providers, editors, and legal
    departments away from more productive missions of
    research, teaching, writing, and patient care

102
Implications of Attacks on Science and Scientists
  • Scientists and health care advocates may decide
    it is wiser to avoid conflict than publish
    content to which ACSH and other such groups might
    object

103
  • Other Examples of Corporate Meddling in Public
    Health

104
WHO Tobacco Treaty
  • U.S. attempted to undermine treaty through Bush
    administration appointees with strong ties to
    tobacco industry

105
Medical Technologies Industry
  • Successful lobbying effort against Medicare
    physician payment policies relevant to unproven
    imaging studies
  • Whole body CT scans (scams)

106
Drug Testing
  • 2011 Florida Governor Rick Scott (R) issues
    executive order requiring drug tests on current
    state workers and new applicants
  • 2011 Scott signs bill requiring drug tests for
    TANF program
  • positive test allows parent to choose another
    individual to receive benefits on behalf of
    children
  • Aid recipients responsible for cost of tests

107
Drug Testing
  • Florida Governor RickScott
  • Former CEO of Columbia/HCA
  • Fired after presiding over massive Medicare fraud
    that cost corporation 1.7 billion federal fine
  • Then set up Solantic (FL chain of emergency care
    clinics) transferred ownership to his wife upon
    entering statehouse
  • Solantic is in the drug-testing business!

108
Corporate Agribusiness
  • Successful campaign against Oregons Proposition
    27 (labeling of GM foods)
  • Lobbying for pre-emptive labeling laws re GMOs,
    rBGH

109
Corporate Agribusiness
  • Supports spread of GMOs to developing world
  • Keeps GM seeds from non-corporate academic
    researchers
  • Promoting agriculture bills which provide large
    subsidies to large industrial farms

110
Corporate Agreements with Medical Associations
  • AAP Abbott Nutrition (manufacturers of Similac)
  • AAP Babies R Us
  • AAFP Coca Cola, Inc.
  • AMA Sunbeam
  • AMA sells access to Physician Masterfile

111
Medical Care
  • Sponsor luxury care consortiums, clinics
  • Facilitate medical tourism
  • Niche in medical transfer market, facilitating
    medical repatriations of undocumented immigrants
    (e.g., MexCare)

112
Health Insurance Industry
  • Dubious practices
  • Delisting
  • Cherry picking
  • Pre-existing conditions
  • Often lower quality of care
  • High administrative costs
  • 15-30 (vs. 2-3 for Medicare and Medicaid)

113
Health Insurance Industry
  • Large profit margins
  • Loyalty shareholders (not patients)
  • Corruption

114
Prison-Industrial Complex
  • Construction and management of prisons
  • Providing (substandard) health care to inmates

115
Pharmaceutical Industry
  • Influence over physicians through control of CME,
    gifts, research funding
  • Conduct seeding trials to alter prescribing
    patterns
  • Secrecy, statistical torturing of data sets,
    selective publication
  • Data mining of prescribing practices
  • Okd by SCOTUS in Sorrell v. IMS Health

116
Drug Company Malfeasance
  • The pharmaceutical industry is the biggest
    defrauder of the federal government, as
    determined by payments made for violations of the
    federal False Claims Act (FCA)
  • Accounted for 25 of all FCA payouts between 2000
    and 2010
  • Defense industry 11

117
Pharmaceutical Industry
  • Effectively lobbied and threatened trade
    sanctions against developing countries in order
    to prevent production and importation of much
    cheaper, generic versions of life-saving
    anti-AIDS drugs

118
Pharmaceutical Industry
  • Opposes legislation aimed at limiting
    pharmaceutical industry influence by publicizing
    gifts to providers
  • Opposes Federal Research Public Access Act, which
    would require federal agencies that fund over
    100 million in external research per year to
    make their study results publicly available online

119
Chemicals Industry
  • Chisso Corporation
  • Methylmercury poisoning
  • Minimata Disease

120
Minimata DiseaseW Eugene Smith
121
Solutions
  • Restructure tax system
  • Punish corporate scofflaws with large fines and
    jail time
  • Increase enforcement budgets to combat corporate
    crime
  • Eliminate confidential legal settlements relevant
    to public health and safety

122
Solutions
  • Living wage laws
  • Work with corporations
  • Healthy PR
  • Shareholder activism
  • Risks/benefits

123
Solutions Fair, Representative Elections
  • Publicly financed campaigns and campaign finance
    reform
  • Open debates, free air time for candidates
  • Proportional representation
  • Instant runoff voting/cumulative voting/range
    (rating) voting

124
Solutions Vote
  • US voter turnout low
  • Wealthy vote at almost twice rate of poor
  • Whites gt Blacks gt Hispanics
  • Old gt Young
  • Property owners gt Renters
  • Physicians lt general population

125
Voter Turnout
126
Solutions
  • Activism / Letter writing / Protesting /
    Whistleblowing
  • Unfortunately, SCOTUS sharply restricted public
    employees whistleblowing rights in Garcetti v.
    Ceballos (2006)

127
Solutions
  • Join community groups become involved in local
    as well as national issues
  • Lobby legislators
  • Run for office

128
Solutions
  • Increase funding of public education
  • Independent scientific review of school curricula
  • Prohibit use of sponsored curricula

129
Solutions
  • Establish safeguards re corporate involvement in
    academic research
  • Higher standards of journalism
  • Support alternative media

130
Solutions Education
  • Medical ethics overemphasizes fascinating
    dilemmas involving expensive technologies (e.g.,
    gene therapy, cloning, face transplants)
  • Medical ethics underemphasizes the psychological,
    cultural, socioeconomic, occupational, and
    environmental contributors to health

131
Solutions Education
  • IOM recommends ¼ to ½ of medical students earn
    the equivalent of an MPH
  • Only 10 of students at US public health schools
    are physicians, down from 60 in the 1960s

132
Solutions
  • Augment and improve international aid package
  • Sign, ratify, and adhere to major international
    treaties
  • Support Millenium Development Goals

133
Air Pollution
134
Factory Farming
135
Global Warming
136
Famine
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138
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139
2009 Federal Budget2.65 trillion
140
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Solutions
  • Based on Precautionary Principle
  • Recognize natures net worth
  • Calculate economic prosperity based on Genuine
    Progress Index or Global Happiness Index, rather
    than Gross Domestic Product

142
Voltaire
  • The comfort of the rich rests upon an abundance
    of the poor

143
  • All men are created equal
  • Declaration of Independence
  • Some people are more equal than others
  • George Orwell

144
Hudson River, 2009
145
Primo Levi
  • A country is considered the more civilized the
    more the wisdom and efficiency of its laws hinder
    a weak man from becoming too weak or a powerful
    one too powerful.

146
Günter Grass
  • The first job of a citizen is to keep your mouth
    open.

147
Anita Roddick
  • "If you think you are too small to have an
    impact, try going to bed with a mosquito in your
    tent"

148
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Contact Information and References
  • Public Health and Social Justice Website
  • http//www.publichealthandsocialjustice.org
  • http//www.phsj.org
  • martindonohoe_at_phsj.org
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