Protecting Public Health from Risky Corporate Practices

Posted on by Corporations and Health Watch
Photo Credit: British American Tobacco

Two current news stories illustrate the challenges the US government faces in protecting the public from corporations that manufacture dangerous products.  A  Huffington Post report posted on October 9th describes how in 1993, Bain and Co., the Boston consulting company where Mitt Romney was CEO, received a $3.9 million contract from the US government to help the Russian government privatize its economy.  At the same time, Bain also had a contract with British American Tobacco (BAT), a conglomerate that produced Kool, Lucky Strike and Pall Mall cigarettes.   In 1992, the Russian government’s monopoly on tobacco production ended.  Bain used its government contract to develop a privatization strategy for Russia, then helped BAT executives to maximize the company’s growth opportunities in this new environment.    

 

Bain also worked for Philip Morris, another Big Tobacco company that was expanding its business in Russia.  In an earlier investigation, the Center for Public Integrity has shown how the marketing and pricing strategies of multinational tobacco companies – and their sweetheart deals with Russian officials – helped increase the rate of smoking among Russian women from 7 % in 1992 to 22% by 2009.  Russian men continue to have among the highest smoking rates in the world.   In Bain’s US work with Philip Morris, reports the Huffington Post, the

consulting company helped Philip Morris  to develop a “coordinated long term approach to legal/regulatory/public

opinion opportunities and challenges to maximize shareholder wealth.” 

 

 

In another story, The New York Times reports that 11 people have died and 119 have become sick in a national meningitis outbreak linked to injections of a contaminated drug .  All of them had been injected with a pain drug shipped around the country by a compounding pharmacy in Massachusetts. Compounding pharmacies are small to midsize businesses that have emerged to exploit gaps in the regulations of the pharmaceutical industry. 

 

Photo Credit: US Food and Drug Administration

“This incident raises serious concerns about the scope of the practice of pharmacy compounding in the US and the current patchwork of federal and state laws,” said a statement by Representative Henry A. Waxman, Democrat of California, and two other Democrats on the House Energy and Commerce Committee, Diana DeGette of Colorado and Frank Pallone Jr. of New Jersey. The committee has jurisdiction over the Food and Drug Administration.

 

Gary Dykstra, a professor at the University of Georgia College of Pharmacy who was the F.D.A.’s deputy associate commissioner for regulatory affairs in the 1990s and retired in 2007, told the Times that Federal drug regulators have tried to crack down on the larger compounding pharmacies with limited success. “They were pushing the limits of pharmacy practice. We were seeing some very clever entrepreneurs that were trying to get a foothold in what they saw as a need but taking it to extremes.” However, inspection proved difficult. They were politically adept, he said, using lobbyists. “They were making a lot of money so they fought us pretty hard,” Mr. Dykstra

said.  “They argued this was a doctor-patient relationship and the F.D.A. couldn’t interfere…We would put a lot of

work into an investigation but our recommendations would find little support.”  The F.D.A. has said it knows of 200

“adverse events,” involving 71 compounded products since 1990.

A Call for Caution on Antipsychotic Drugs

Posted on by Corporations and Health Watch

The number of annual prescriptions for atypical antipsychotics rose to 54 million in 2011 from 28 million in 2001, a 93 percent increase, according to IMS Health. One study found that the use of these drugs for indications without federal approval more than doubled from 1995 to 2008. In a column in The New York Times, Dr. Richard Bernstein notes that originally experts believed the new drugs were more effective than the older antipsychotics against such symptoms of schizophrenia. However, several recent large randomized studies failed to show that the new antipsychotics were any more effective or better tolerated than the older drugs.

Bringing Corporations and Health into the Public Health Curriculum

Posted on by Corporations and Health Watch

As public health students and faculty head back to school this week, Corporations and Health Watch continues its tradition of starting the academic year with a commentary on teaching about corporations and health. Our argument for including teaching about the impact of corporations on health in public health and related academic programs is based on the following premises:

 

  • Corporations are the dominant economic and political institution of the 21st century and thus have a profound influence on global well-being.
  • The business and political practices of corporations are a modifiable social determinant of health and thus a promising target for public health interventions.
  • To achieve local, national and global public health goals of reducing premature mortality, shrinking inequalities in health,  and controlling non-communicable diseases and injuries  will require making changing corporate behavior as important a public health priority as changing individual behavior.
  • Few public health academic programs adequately prepare their students to investigate, analyze or contribute to modifying the corporate policies and practices that harm health.

 

Professor Rudolph Virchow
Photo credit

To be effective in fulfilling their responsibility to prevent illness, promote health and reduce health inequalities, public health professionals should be able to demonstrate the following competencies:

 

  1. Identify corporate business and political practices that affect health.
  2. Develop public health strategies to encourage health-promoting corporate practices and discourage or end health-damaging ones.
  3. Analyze the public health advantages and disadvantages of various government/market relationships
  4. Create alliances with consumer, environmental, labor  and health organizations and movements that seek to  change harmful corporate practices and policies
  5. Describe the roles of public health professionals and researchers in modifying harmful corporate practices or policies.

 

These competencies can be developed in several ways.  Core public health courses can includes sessions on these topics as they relate to, for example, epidemiology, health policy, environmental health, or health education.  Some programs have developed specialized courses on the topic, allowing interested students to pursue this interest.  (To see a  syllabus for a doctoral course Interdisciplinary Perspectives on Corporations and Health 1900-2012 at City University of New York  click here to request a copy.)  Or a student-faculty interest group can bring together those who want to pursue research, advocacy or practice on the corporate impact on public health. 

 

Front entrance to the Bloomberg School of Public Health
Photo credit

 

For the time being, you’re more likely to find a corporate name on the front of a school of public health than to have corporate practices discussed in the classroom.  Fortunately, however, a growing number of resources are available to faculty who want to teach about this topic and students who want to learn more or write papers on corporations and health.  I offer here a short list of such sources.

 

 

 

 

 

 

 

 

 

 

 

 

10 Sources on Corporations and Health for Use in Basic Public Health Classes

(with suggestions for use in Epidemiology (EPI), Health Policy & Management (HPM), Social and Behavioral Health (SBH), or Environmental & Occupational Health (EOH) Core Courses)

 

Biglan A. Corporate Externalities: A Challenge to the Further Success of Prevention Science.  Prev Sci. 2011; 12(1): 1–11. (HPM, SBH)

Brandt AM.  Inventing conflicts of interest: a history of tobacco industry tactics. Am J Public Health. 2012;102(1):63-71.(EPI, SBH, HPM)

Freudenberg N, Galea S. The impact of corporate practices on health: implications for health policy. J Public Health Policy. 2008;29(1):86-104 (SBH,HPM)

Hastings G. Why corporate power is a public health priority. BMJ. 2012;345:e5124.(EPI, HPM, SBH)

Huff, J. 2007. Industry influence on occupational and environmental public health. International Journal of Occupational and Environmental Health 13.1: 107–117. (EPI, EOH)

Labonté R, Mohindra KS, Lencucha R.  Framing international trade and chronic disease.  Global Health. 2011 Jul 4;7(1):21.(EPI, SBH,HPM)

Ludwig DS, Nestle M. Can the food industry play a constructive role in the obesity epidemic? JAMA. 2008 Oct 15;300(15):1808-11.(SBH,HPM)

Stuckler D, McKee M, Ebrahim S, Basu S Manufacturing Epidemics: The Role of Global Producers in Increased Consumption of Unhealthy Commodities Including Processed Foods, Alcohol, and Tobacco. PLoS Med 2012;  9(6): e1001235. (EPI, SBH, HPM)

Wiist, W.H. (Ed). Bottom Line or Public Health. Tactics Corporations Use to Influence Health and Health Policy, and What We Can Do to Counter Them. NY: Oxford University Press, 2010. (relevant chapters for all 4 courses)

Woodcock J, Aldred R. Cars, Corporations, and Commodities: Consequences for the Social Determinants of Health. Emerging Themes in Epidemiology. 2008 Feb 21;5:4.  (EPI, EOH, SBH)

 

 

In addition to these selected resources, a bibliographic essay on Business and Corporate Practices can be found in the Public Health section of Oxford Online Bibliographies.

 

Finally, several Corporations and Health Watch contributing writers have websites or blogs that include additional timely material.  Check out these sites:  David Jernigan, Michele Simon, Bill Wiist.

 

 

Previous CHW Posts on Teaching about Corporations and Health

 

10 Ways to Bring the Health Impact of Business Practices into the Classroom  September 2011

Teaching about Corporations and Health  June 2010

Teaching about Corporations and Health: Bringing Corporate Practices into Public Health Classrooms  December 2007

Antipsychotic Drug Prescriptions for Off-label Conditions Increase for Children and Youth

Posted on by Corporations and Health Watch

In an article published this month in the Archives of General Psychiatry, Mark Olfson and his colleagues reported that between 1993-1998 and 2005-2009, visits with a prescription of antipsychotic medications per 100 persons increased almost eightfold for children, almost five fold for adolescents, and almost doubled for adults. Only a small proportion of child and adolescent antipsychotic visits included an FDA clinical indication; many prescriptions were for off-label use.  An earlier commentary by the psychiatrist Dr. Peter Breggin on the Huffington Post links this increased use to unethical drug company marketing practices. 

Massachusetts Repeals No Free Lunch Ban for Doctors

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Massachusetts has repealed a 2008 state ban on industry-provided meals for physicians and other health professionals,  American Medical News reports.   The change allows medical industry companies to pay for “modest meals and refreshments” for doctors and other health professionals in connection with educational presentations that are not certified by the Accreditation Council for Continuing Medical Education. Restaurateurs, pharmaceutical companies and device-makers had lobbied for the repeal, which was included in the state’s $32.5 billion 2013 budget enacted in July.

Big Pharma’s Future Profits to Come from Brazil, India and China

Posted on by Corporations and Health Watch

Just as the tobacco, food and beverage and automobile industries see their future in China, India and Brazil, a new report from IMS Institute for Healthcare Informatics finds that rising incomes among consumers in these emerging markets will drive global growth in pharmaceutical spending over the next five years. This is good news for the drug industry, which is struggling to maintain sales in the United States and Europe as patent expirations and price controls eat into profits.

Merck Cribs Page from McDonald’s Playbook

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In a complaint filed with the Federal Trade Commission, reports the New York Times, the Public Health Advocacy Institute and 10 other groups called Merck’s marketing strategy for Children’s Claritin dangerous and deceptive, pointing to the inclusion of Madagascar stickers in some boxes of the product, the creation of activity books that parents can download for their children and the enlistment of a team of mothers who blog to hold Claritin-themed Madagascar viewing parties for their children and friends.

Rio +20: Aligning Campaigns against Global Warming and Rise of Non-Communicable Diseases

Posted on by Corporations and Health Watch

This week, 50,000 delegates will gather in Rio de Janiero for the United Nations Conference on Sustainable Development. While the slogan is ambitious — “the future we want,” in comparison to the first Earth Summit held in Rio in 1992, the goals of this twentieth anniversary celebration are modest. As Andrea Correa de Lago, Brazil’s head of environment at the Ministry of Foreign Affairs and chief negotiator on climate change, said  last February, “It is not an idealistic conference, we are not going to say we are saving the planet through goals and measures that we know are not going to be taken seriously.”

Rather, the opportunity for this meeting is to create a framework for longer term discussion about how best to promote a sustainability agenda. One difference for this year’s conference compared to 1992 will be the active participation of city governments, NGOs, and the private sector. As a result, said Rodrigo Rosa, Rio+20 coordinator at Rio de Janeiro’s Mayor’s Office, “Rio+20’s strength will not be inside the offices, but in the movement. This year we’ll have a great amount of parallel events that didn’t happen in 1992. Politicians are reactive, they take decisions after there’s will in civil society. I think Rio+20 will contribute to that.”

For public health activists seeking to build a movement for sustainability, Rio+20 provides an opportunity to consider the causes and solutions to two of the gravest threats to global sustainability: human-induced climate change and the rise of non-communicable diseases (NCDs) such as cardiovascular disease, diabetes, cancer and respiratory conditions. A recent report in Lancet summarizes the connections between climate change and NCDs, arguing that many of the world’s “development goals have not been achieved partly because social (including health), economic, and environmental priorities have not been addressed in an integrated manner.”

As Manish Bapna, Acting President and Executive Vice President & Managing Director of the World Resources Institute recently observed, developing effective strategies to achieve more sustainable economic growth requires addressing two related trends:

  • The rise of the multinational corporations. Having grown dramatically in size, reach, and number in recent decades, global corporations wield increasing influence over the environment and society. Global supply chains only magnify their role. Today, what happens in a factory in China, South Africa, or Thailand can reverberate around the planet.                             
  • The expansion of the global middle class. Exploding growth in the developing world has created a vast new middle class, which could near five billion by 2030, of whom 66 percent will live in Asia. That is a lot of new consumers. How will they live, eat, shop, and get to work? Will they emulate the worst habits of the developed world, or will they embrace a role as better stewards of the planet?

In fact, the rise of  both NCDs and global warming in the last few decades can be explained in significant part by the efforts of multinational corporations in the automobile, energy, food and beverage, tobacco, alcohol, pharmaceutical and other industries to target these emerging middle classes in China, India, Brazil, Indonesia and elsewhere for their brand of hyper consumption. As markets become saturated in developed nations, these new markets are the corporations’ hope for profitability in this century. But the lifestyle that corporations promote to achieve their business goals is itself a fundamental cause of unsustainable energy use and chronic diseases. Its remedy requires changing not individual behavior but corporate practices. As the Third World Network, an NGO in Malaysia, put it in their Rio+20 briefing paper, “If governments want to enable sustainable development, then they must regulate transnational corporations who are drivers of unsustainable development.”

In past global meetings, much of the focus has been on what governments can and should do, an important and appropriate topic of discussion. But it is equally important to ask what corporations cannot do if sustainable growth is to be achieved. A  Lancet editorial hopes that in the future, Rio+20 “is looked upon as launching a new era for human wellbeing, one that is rooted in principles of equity, social justice, and sustainability.” Achieving that goal will require a willingness to reconsider the role of multinational corporations in today’s world. Rio+ 20 will be judged on its progress in this critical task.

Merck Settles on Vioxx in New York and Sentenced in Massachusetts

Posted on by Corporations and Health Watch

The New York Attorney General Eric T. Schneiderman announced last week  that he has secured a settlement with Merck Sharp & Dohme Corp., a unit of Merck & Co., resolving civil and criminal charged that the pharmaceutical giant marketed its drug Vioxx for uses not approved by the United States Food and Drug Administration, and misrepresented the cardiovascular safety of the drug. As part of the multistate and federal agreement, Merck will pay a total of $615 million in civil damages and penalties to compensate Medicaid, Medicare and other governmental healthcare programs – over $61 million of which will be paid to New York State, Schneiderman said.  In addition, , the U.S. Attorney’s Office for the District of Massachusetts said that Merck, Sharp & Dohme was sentenced by U.S. District Court Judge Patti B. Saris to pay a criminal fine in the amount of $321.64 million in connection with its guilty plea related to its promotion and marketing of the painkiller Vioxx (rofecoxib).

Arkansas Judge Fines Johnson & Johnson $1.1 Billion for Hiding Drug Risks

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An Arkansas judge has fined Johnson & Johnson and a subsidiary more than $1.1 billion after a jury found the companies downplayed and hid risks associated with an antipsychotic drug, reports CBS News. Judge Tim Fox found nearly 240,000 violations under Arkansas’ Medicaid-fraud law over Risperdal. Each violation came with a $5,000 fine, setting the total penalty at more than $1.1 billion. Arkansas sued Johnson & Johnson and subsidiary Janssen pharmaceuticals Inc. in 2007 over the drug.