Back to School Books on Corporations and Health

Posted on August 6, 2014 by Corporations and Health Watch

For those who make a living teaching about health, August means getting ready for returning to the classroom and introducing new students to what we think is important. A basic premise of Corporations and Health Watch is that every health professional should understand something about the ways corporations influence health and what can be done to prevent or modify corporate practices that harm health.

To help CHW readers contribute to that goal, I suggest five books to add to public health, medical, nursing, social work or related course readings and discussions. These books have been published or updated in the last year or so, are available for less than $30, and can be used in a variety of courses including introductory public health, health policy, social and behavioral health, epidemiology or social epidemiology and more specialized courses.

I suggest books –in addition to the texts and journal articles we usually assign—because they give students an opportunity to read in more depth on a single topic, evaluate the range of evidence that authors present, and react to the opinions the authors draw from this evidence. The brief descriptions of each book are those provided by the publisher.

Corporations Are Not People: Reclaiming Democracy from Big Money and Global Corporations

By Jeff Clements, Updated Edition, 2014, Berrett and Kohler

Describes the new fabrication of rights and power for corporations and money, at the expense of the rights of human beings and of democracy itself. A resource for everyone who want to join the historic work to overcome partisan divides and re-engage in self-government by all Americans — community by community, state by state, and, ultimately, in Washington itself. This 2014 edition is updated throughout with surprising information and analysis about the impacts of unlimited money in federal, state, and even local elections; the spreading “corporate capture of the courts” resulting from the dangerous fabrication of “corporate rights” in the Constitution; and the growing, historic response from people of all political viewpoints to defend democracy and rebuild government of the people. A completely new chapter—“Do Something”- shows how thousands of so-called ordinary people are working to build the “most dynamic, grass-roots movement in the United States,” and offers “portals” for people to connect and act.

The Gun Debate What Everyone Needs to Know
Philip J. Cook and Kristin A. Goss, Oxford University Press, 2014

No topic is more polarizing than guns and gun control. From a gun culture that took root early in American history to the mass shootings that repeatedly bring the public discussion of gun control to a fever pitch, the topic has preoccupied citizens, public officials, and special interest groups for decades. The Gun Debate: What Everyone Needs to Know® delves into the issues that Americans debate when they talk about guns. With a balanced and broad-ranging approach, noted economist Philip J. Cook and political scientist Kristin A. Goss thoroughly cover the latest research, data, and developments on gun ownership, gun violence, the firearms industry, and the regulation of firearms. The authors also tackle sensitive issues such as the effectiveness of gun control, the connection between mental illness and violent crime, the question of whether more guns make us safer, and ways that video games and the media might contribute to gun violence. No discussion of guns in the U.S. would be complete without consideration of the history, culture, and politics that drive the passion behind the debate. Cook and Goss deftly explore the origins of the American gun culture and the makeup of both the gun rights and gun control movements.

Lethal But Legal Corporations, Consumption, and Protecting Public Health
Nicholas Freudenberg, Oxford University Press, 2014

Decisions made by the food, tobacco, alcohol, pharmaceutical, gun, and automobile industries have a greater impact on today’s health than the decisions of scientists and policymakers. As the collective influence of corporations has grown, governments around the world have stepped back from their responsibility to protect public health by privatizing key services, weakening regulations, and cutting funding for consumer and environmental protection. Today’s corporations are increasingly free to make decisions that benefit their bottom line at the expense of public health. Lethal but Legal examines how corporations have influenced — and plagued — public health over the last century, first in industrialized countries and now in developing regions. It is both a current history of corporations’ antagonism towards health and an analysis of the emerging movements that are challenging these industries’ dangerous practices. The reforms outlined here aim to strike a healthier balance between large companies’ right to make a profit and governments’ responsibility to protect their populations. While other books have addressed parts of this story, Lethal but Legal is the first to connect the dots between unhealthy products, business-dominated politics, and the growing burdens of disease and health care costs. By identifying the common causes of all these problems, then situating them in the context of other health challenges that societies have overcome in the past, this book provides readers with the insights they need to take practical and effective action to restore consumers’ right to health.

Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients
by Ben Goldacre (New paperback edition, 2014) Macmillan Publishers.

We like to imagine that medicine is based on evidence and the results of fair testing and clinical trials. In reality, those tests and trials are often profoundly flawed. We like to imagine that doctors who write prescriptions for everything from antidepressants to cancer drugs to heart medication are familiar with the research literature about these drugs, when in reality much of the research is hidden from them by drug companies. We like to imagine that doctors are impartially educated, when in reality much of their education is funded by the pharmaceutical industry. We like to imagine that regulators have some code of ethics and let only effective drugs onto the market, when in reality they approve useless drugs, with data on side effects casually withheld from doctors and patients. All these problems have been shielded from public scrutiny because they are too complex to capture in a sound bite. Ben Goldacre shows that the true scale of this murderous disaster fully reveals itself only when the details are untangled. He believes we should all be able to understand precisely how data manipulation works and how research misconduct in the medical industry affects us on a global scale. With Goldacre’s characteristic flair and a forensic attention to detail, Bad Pharma reveals a shockingly broken system in need of regulation. This is the pharmaceutical industry as it has never been seen before.

Food Politics: How the Food Industry Influences Nutrition and Health by Marion Nestle, University of California Press, Revised and Updated Paperback, 2013

We all witness, in advertising and on supermarket shelves, the fierce competition for our food dollars. In this engrossing exposé, Marion Nestle goes behind the scenes to reveal how the competition really works and how it affects our health. The abundance of food in the United States—enough calories to meet the needs of every man, woman, and child twice over—has a downside. Our overefficient food industry must do everything possible to persuade people to eat more—more food, more often, and in larger portions—no matter what it does to waistlines or well-being. Like manufacturing cigarettes or building weapons, making food is very big business. Food companies in 2000 generated nearly $900 billion in sales. They have stakeholders to please, shareholders to satisfy, and government regulations to deal with. It is nevertheless shocking to learn precisely how food companies lobby officials, co-opt experts, and expand sales by marketing to children, members of minority groups, and people in developing countries. We learn that the food industry plays politics as well as or better than other industries, not least because so much of its activity takes place outside the public view.

For previous Corporations and Health Watch Back to School posts see:
Corporations and Health Watch Goes Back to School: 10 Recent Articles for Fall 2013 Courses
Bringing Corporations and Health into the Public Health Curriculum
Corporations and Health Watch Goes Back to School: 10 Ways to Bring the Health Impact of Business Practices into the Classroom

“Hide No Harm” Bill Will Tip the Balance in Favor of Science and Safety over Corporate Profits

Posted on August 4, 2014 by Corporations and Health Watch

Cross-posted from The Equation

On July 16, Senators Richard Blumenthal (CT), Tom Harkin (IA) and Robert Casey (PA) introduced S. 2615, the “Hide No Harm Act.” Their legislation would impose criminal penalties—fines and even imprisonment—on corporate executives if they knowingly failed to warn the public about life-threatening dangers in their products.

Senator Blumenthal introduced the “Hide No Harm Act” because it is time to hold executives accountable when public health and safety are at stake.

The bill was prompted by revelations that executives at General Motors had ignored red flags about the ignition switch in many GM models, a switch that could suddenly shut down power to the car, including its air bags. The product defect has been implicated in at least 13 deaths and many injuries. After GM learned about the defective part, the company took years to warn consumers or address the problem.

But the “Hide No Harm” bill addresses a more fundamental problem than one company’s mishandling of a significant product hazard. It aims to give the public and regulatory agencies timely access to public health and safety information, so that deaths and serious injuries can be avoided.

The bill requires that corporate officers and executives—the people running companies—disclose information about these dangers to the appropriate government agency, and warn employees and consumers. They must issue these warnings promptly, not years after the company detects the problem. The bill also makes clear that corporate managers may not retaliate against any conscientious employee who discloses these dangers.

The science connection

What does this legislation have to do with scientific integrity? Quite a bit. In numerous cases, scientists, engineers, and technicians working for corporations have raised concerns about product safety, only to be ignored by corporate accountants, marketers and lawyers.

If corporate executives know that they can be held directly accountable for their actions, it may persuade them to pay more attention to the potential harms a product may cause, and may tip the balance in favor of the scientific evidence that raises red flags. Whistleblowers are invaluable in helping to identify problems before they create deaths and injuries.

In GM’s case, Courtland Kelley, then the head of an inspection program for GM products throughout the country, raised concerns about safety problems he was finding in GM models in 2002. He tried to take his concerns to company managers, but was rebuffed. He sued the company to help prompt corrective action, using Michigan’s whistleblower law. But his efforts sandbagged his career at the auto company, with the company downgrading his duties.

The way that engineer was treated affected others at GM, who kept quiet when in 2004, reports were surfacing about another safety defect in ignitions. The recall of millions of cars, not to mention the loss of lives, could have been prevented if GM managers welcomed safety concerns and did not punish whistleblowers.

No spinning science

Vioxx was a huge money maker, a painkiller that reportedly was easier on the stomach than older pain pills such as aspirin. But as early as 2000, in a clinical trial of 8,000 patients comparing Vioxx to the painkiller naproxen, researchers found that five times as many Vioxx patients had heart attacks as those on naproxen.

Merck did disclose the findings of the clinical trial to the Food and Drug Administration and to the media, but it spun the message. It stressed that Vioxx caused fewer digestive problems than naproxen, and concluded that naproxen must have some property that protects the heart, thus explaining away any possible harm Vioxx might do.

In truth, Merck’s scientists were concerned about the clinical trial, wondering whether the drug was truly safe. Some corporate scientists were so worried that they proposed withdrawing the drug until their questions could be answered.

Merck failed to address its scientists’ concerns. The company did not try to determine what caused this uptick in heart attacks. Was naproxen really protective for the heart, or did Vioxx potentially cause heart problems?

Instead, the company opted to monitor clinical trials looking at other aspects of Vioxx to see if any disturbing trends turned up. It continued to insist on the safety of its drug even after the Journal of the American Medical Association (JAMA) in 2001 published the findings of two Cleveland Clinic cardiologists who re-analyzed data from several Vioxx clinical trials and concluded that the drug did raise the risk of heart attack and stroke.

Even worse, despite all these unresolved questions and emerging red flags, the company sold the drug to doctors for a use that the FDA had not yet approved—to treat rheumatoid arthritis.

At Merck, the marketers and bean counters prevailed over the scientists who wanted more answers. Merck took four years to voluntarily withdraw the drug from the market. Withdrawal occurred only after a much larger clinical trial established the damage Vioxx could do. As a consequence, tens of thousands of patients who took Vioxx suffered fatal heart attacks.

Accountability is important

Merck ultimately sold Vioxx to 25 million Americans. Global sales of the drug totaled $2.5 billion the year before it was withdrawn. (The FDA also has earned justifiable criticism for its lax regulation of Vioxx and its efforts to suppress the warnings of Dr. David Graham, an FDA scientist who also sounded the alarm about the painkiller).

After misrepresenting the science, Merck was able to celebrate billions of dollars in profits off a drug that was directly linked to thousands of heart attacks.

The government did punish the company, levying a $950 million fine in 2011, which also resolved civil suits in several states. In 2007, Merck paid more than $4.8 billion to settle 27,000 lawsuits by those who claimed they or their relatives suffered injury or death due to Vioxx.

But Merck executives were not held accountable by the U.S. Department of Justice. The DOJ’s charges concerned illegal marketing, and not the more fundamental wrongdoing of failing to adequately or promptly warn patients of the potential dangers of the drug, and not taking action for four years, while the evidence of serious concerns about Vioxx’s safety continued to mount. Indeed Merck’s press release announcing the negotiated deal made just that point: “As part of the plea agreement, the United States acknowledged that there was no basis for a finding of high-level management participation in the violation. The government also recognized Merck’s full cooperation with its investigation.”

It is time for corporate executives to be held personally accountable for subsuming the concerns of their scientists and others in the scientific community for the sake of profits and share price. Fines, even large ones, can be offset by the astounding money that can be made from an unsuspecting public.

As Erik Gordon, an assistant professor of business at the Ross School of Business at the University of Michigan told the New York Times: “It’s just a cost of doing business until a pharmaceutical executive does a perp walk.”

Celia Wexler is a senior Washington representative for the Scientific Integrity Initiative at UCS. A former award-winning journalist, Wexler is the author of Out of the News: Former Journalists Discuss a Profession in Crisis, published in 2012 by McFarland. At UCS, Wexler’s issue portfolio includes food and drug safety, protections for scientist whistleblowers, and government transparency and accountability. See Celia’s full bio.

New Legislation Would Allow Criminal Penalties Against Corporate Officers Who Hide Information on Dangerous Products

Posted on July 23, 2014 by Corporations and Health Watch

Consumer safety, public health, environmental and other groups in the Coalition for Sensible Safeguards lauded a new bill introduced by U.S. Sen. Richard Blumenthal (D-Conn.), co-sponsored by Sens. Bob Casey (D-Pa.) and Tom Harkin (D-Iowa). The “Hide No Harm” bill would hold corporate officers criminally accountable if they knowingly conceal serious dangers that lead to consumer or worker deaths or injuries. Penalties could include jail time. Read more from the Consumer Federation of America.

Is Tax the Next Big Corporate Social Responsibility Issue?

Posted on June 25, 2014 by Corporations and Health Watch

Writing for the International Centre on Tax and Development, Isabel de la Peña observes that “Transnational Corporations operating in the global economy have a wide range of possibilities to avoid their responsibility to pay taxes.” She calls on corporate responsibility groups to add tax avoidance to their agendas.

WHO Proposes Framework of Engagement with Non-state Actors

Posted on May 14, 2014 by Corporations and Health Watch

As part of WHO reform, the WHO Secretariat has submitted a draft framework for engagement with non-State actors, which contains: (a) an overarching framework for engagement with non-State actors, and (b) four separate WHO policies and operational procedures on engagement with nongovernmental organizations, private sector entities, philanthropic foundations and academic institutions.

Most Polluted U.S. Cities

Posted on May 7, 2014 by Corporations and Health Watch

A new report from the American Lung Association lists the cities that have the worst air pollution in the U.S. In many places, such as Southern California and the Central Valley, including Los Angeles, Fresno, Visalia and Modesto, Las Vegas, and Salt Lake City, automobile and truck exhaust are primary contributors to the pollution and the health problems it causes.

Business Gears Up for Assault on Consumer-Protection Laws

Posted on May 1, 2014 by Corporations and Health Watch

That low rumbling you hear, writes Bloomberg Businessweek is the business lobby revving its engines for an assault on state consumer-protection laws. The corporate-funded American Tort Reform Association gave fair warning at an event in Washington last week, when it announced “a multiyear, multistate campaign to reform such laws.” By “reform,” ATRA means water down, roll back—choose your metaphor.

Public Health Advocacy Institute Files Amicus Brief Comparing Gambling and Tobacco Industries

Posted on May 1, 2014 by Corporations and Health Watch

cross-posted by Public Health Advocacy Institute

A 1912 panel from a restaurant in Germany that shows drinking, smoking gamblers. Credit

The Public Health Advocacy Institute has filed an amicus curiae brief in an appeal pending before the Massachusetts Supreme Judicial Court. The Plaintiff/Appellants are seeking to reverse a decision of the attorney general and get a question certified for inclusion on the 2014 ballot to repeal a law legalizing casino gambling in Massachusetts. The case is Steven P. Abdow et al., v. Attorney General, et al., No. SJC-11641.

Legalized casino gambling causes devastating effects on the public’s health, including not only the gambler but also their families, neighbors, communities and others with whom they interact. Massachusetts voters should not be denied the opportunity to be heard directly on the question of whether to invite a predatory and toxic industry to do business in the Commonwealth.

The harm caused by the tobacco industry’s products has been the archetype of a commercial threat to public health, and in considering the introduction of gambling industry casinos into Massachusetts, much can be learned from the object lesson of considering the tobacco industry as a disease vector. The predatory gambling industry shares much in common with the tobacco industry.

Some examples of the similarities are:

Casinos employ electronic gambling machines that are designed to addict their customers in a way that is similar to how the tobacco industry formulates its cigarettes to be addictive by manipulating their nicotine levels and other ingredients.

Mirroring the tobacco industry’s strategy of creating scientific doubt where none truly exists, the casino industry has co-opted and corrupted scholarship on the effects of gambling through the use of front groups that funnel money to beholden scientists who are able to sanitize its origin.

Borrowing another tobacco industry technique of shaping the debate around its products, by creating a misleading lexicon and using euphemisms, the casino industry has tried to influence debate, deflect criticism and mislead the public about its role as a disease vector.

By employing personal and corporate responsibility rhetoric honed by the tobacco industry, the casino industry hopes to gain and maintain social acceptability and stave off litigation, regulation and citizen-driven activism.

Both the tobacco and casino industries profit from preying upon society’s most vulnerable members, acting as disease vectors which adversely affect the physical, emotional and social health of the individual users and the communities where use of the products is prevalent.

The brief declares that the voters of the Commonwealth should be allowed to act on their own behalf in expressing an opinion of this type of predatory behavior. The power of the citizen ballot initiative is the ultimate in personal responsibility, agency and self-determination. Therefore, PHAI asks the court to compel the attorney general to certify the Plaintiffs’/Appellants’ petition and allow the repeal measure to be included on the 2014 ballot.

The full brief can be downloaded here.

Seven Million Premature Deaths Annually Linked to Air Pollution

Posted on March 27, 2014 by Corporations and Health Watch

World Health Organization News release

25 March 2014 | Geneva – In new estimates released today, WHO reports that in 2012 around 7 million people died – one in eight of total global deaths – as a result of air pollution exposure. This finding more than doubles previous estimates and confirms that air pollution is now the world’s largest single environmental health risk. Reducing air pollution could save millions of lives.

New estimates

In particular, the new data reveal a stronger link between both indoor and outdoor air pollution exposure and cardiovascular diseases, such as strokes and ischaemic heart disease, as well as between air pollution and cancer. This is in addition to air pollution’s role in the development of respiratory diseases, including acute respiratory infections and chronic obstructive pulmonary diseases.

The new estimates are not only based on more knowledge about the diseases caused by air pollution, but also upon better assessment of human exposure to air pollutants through the use of improved measurements and technology. This has enabled scientists to make a more detailed analysis of health risks from a wider demographic spread that now includes rural as well as urban areas.

Regionally, low- and middle-income countries in the WHO South-East Asia and Western Pacific Regions had the largest air pollution-related burden in 2012, with a total of 3.3 million deaths linked to indoor air pollution and 2.6 million deaths related to outdoor air pollution.

“Cleaning up the air we breathe prevents non-communicable diseases as well as reduces disease risks among women and vulnerable groups, including children and the elderly…”

Dr Flavia Bustreo, WHO Assistant Director-General Family, Women and Children’s Health

“Cleaning up the air we breathe prevents noncommunicable diseases as well as reduces disease risks among women and vulnerable groups, including children and the elderly,” says Dr Flavia Bustreo, WHO Assistant Director-General Family, Women and Children’s Health. “Poor women and children pay a heavy price from indoor air pollution since they spend more time at home breathing in smoke and soot from leaky coal and wood cook stoves.”

Included in the assessment is a breakdown of deaths attributed to specific diseases, underlining that the vast majority of air pollution deaths are due to cardiovascular diseases as follows:

Outdoor air pollution-caused deaths – breakdown by disease:

40% – ischaemic heart disease;
40% – stroke;
11% – chronic obstructive pulmonary disease (COPD);
6% – lung cancer; and
3% – acute lower respiratory infections in children.

Indoor air pollution-caused deaths – breakdown by disease:

34% – stroke;
26% – ischaemic heart disease;
22% – COPD;
12% – acute lower respiratory infections in children; and
6% – lung cancer.

The new estimates are based on the latest WHO mortality data from 2012 as well as evidence of health risks from air pollution exposures. Estimates of people’s exposure to outdoor air pollution in different parts of the world were formulated through a new global data mapping. This incorporated satellite data, ground-level monitoring measurements and data on pollution emissions from key sources, as well as modelling of how pollution drifts in the air.

Risks factors are greater than expected

“The risks from air pollution are now far greater than previously thought or understood, particularly for heart disease and strokes,” says Dr Maria Neira, Director of WHO’s Department for Public Health, Environmental and Social Determinants of Health. “Few risks have a greater impact on global health today than air pollution; the evidence signals the need for concerted action to clean up the air we all breathe.”

After analysing the risk factors and taking into account revisions in methodology, WHO estimates indoor air pollution was linked to 4.3 million deaths in 2012 in households cooking over coal, wood and biomass stoves. The new estimate is explained by better information about pollution exposures among the estimated 2.9 billion people living in homes using wood, coal or dung as their primary cooking fuel, as well as evidence about air pollution’s role in the development of cardiovascular and respiratory diseases, and cancers.

In the case of outdoor air pollution, WHO estimates there were 3.7 million deaths in 2012 from urban and rural sources worldwide.

Many people are exposed to both indoor and outdoor air pollution. Due to this overlap, mortality attributed to the two sources cannot simply be added together, hence the total estimate of around 7 million deaths in 2012.

“Excessive air pollution is often a by-product of unsustainable policies in sectors such as transport, energy, waste management and industry. In most cases, healthier strategies will also be more economical in the long term due to health-care cost savings as well as climate gains,” says Dr Carlos Dora, WHO Coordinator for Public Health, Environmental and Social Determinants of Health. “WHO and health sectors have a unique role in translating scientific evidence on air pollution into policies that can deliver impact and improvements that will save lives.”

The release of today’s data is a significant step in advancing a WHO roadmap for preventing diseases related to air pollution. This involves the development of a WHO-hosted global platform on air quality and health to generate better data on air pollution-related diseases and strengthened support to countries and cities through guidance, information and evidence about health gains from key interventions.

Later this year, WHO will release indoor air quality guidelines on household fuel combustion, as well as country data on outdoor and indoor air pollution exposures and related mortality, plus an update of air quality measurements in 1600 cities from all regions of the world.

Industry Voices Dominate the Trade Advisory System

Posted on March 6, 2014 by Corporations and Health Watch

The Obama administration’s corporate-heavy network of official trade advisers has emerged as a point of sharp contention in a process that has been criticized by members of Congress and others as low on public transparency. In a series of infographics, the Washington Post shows the corporate and other ties of the 566 individuals who work with the Obama administration to establish trade policy.