There us all. Despite the different health

There is no medicine without medicines. Big
Pharma, the nickname given to the pharmaceutical industry is a bit of a
misnomer. While the focus is pharmaceutical companies and their actions,
there are several enablers in the health care system – medical journals,
regulators, and even medical professionals, all of whom have put the industry’s
needs ahead of good medicine.  The harm
is unavoidable and profound, right to the roots of advanced medicine. These
issues know no borders, and influence us all. Despite the different health care
systems that exist around the world, we all depend on for-profit pharmaceutical
companies to develop and market modern medicines. These companies collectively
use enormous influence, due in portion to the remarkable success of drugs over
the past a few decades.

The harm is unavoidable and profound,
right to the roots of advanced medicine. These issues know More people today are on
prescription drugs than ever before. As the population ages and health
conditions become more difficult to manage there will be an increased need for
safe and effective drugs. However, in recent years there has been a flood of
lawsuits against major drug companies for hiding information about unsafe drugs
as well as committing other fraudulent practices. Yet there has been little to
nothing that stops them from continuing to do this. Some wonder how it is
possible for this situation to continue unabated.

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There is a Thin Line between Ethical and Legal

 

Just because a business practice is
legal doesn’t mean it’s ethical. But does that mean it’s OK for CEOs to
maximize profits by following perfectly legal business practices that cross the
line into unethical waters? Their stance would be that a CEO’s main
responsibility is to maximize profits and shareholder value within legal
parameters, even if that means having low ethical standards. Others would argue
that CEOs have a social responsibility to conduct business in an ethical manner
even if that means securing a slightly lower return on investment.

 

One of the most controversial business
decisions in recent years was when Martin Shkreli, former CEO of Turing
Pharmaceuticals, raised the price of the drug Daraprim by 5000%. By increasing
the price from $13.50 per pill to $750 per pill overnight. Shkreli’s
argument was that by raising the price of the drug, Turing would be able to put
money into developing better treatments for toxoplasmosis.

 

What Shkreli did was no different than
what other pharmaceutical companies have done for years. For example, when
Valeant Pharmaceuticals acquired cardiac drugs Isuprel and Nitropress and
quickly raised the prices by 525% and 212%, respectively. Shkreli raising the
price of Daraprim by 5,000% may be considered more brash. It was also perfectly
legal. And unethical.

 

The number one spot for Big Pharma fraud
unquestionably goes to GSK. They have the most drugs that have been
investigated for negative health effects to date. They also have a track record
for the most insidious types of fraud. This includes bribing doctors to
prescribe their drugs, using fraudulent research papers to cover up dangerous
side effects and allowing the FDA to continue to let them manufacture their
products. They also have marketed their medicines off-label that they were
never approved to treat. GSK paid $3 billion in settlements for their line of
antidepressants alone including Paxil, Wellbutrin, and Avandia. But the total
revenue from these three drugs was over $28 billion. Since then the company has
done little to mend its ways and seems to be undeterred as more and more
profits from newly approved drugs continue to fill its bank account.

 

Policies Procedures and other Considerations

Stakeholders
in the pharmaceutical sector must be held accountable for their actions.
Governments must implement processes to track activities and provide civil
society organizations with access to data so they are able to act as watchdogs.
Governments must also do more to ensure all regulation and legislation is
actively enforced to ensure corrupt pharmaceutical companies are investigated
and punished, with evidence suggesting that in many cases the level of fines
must be raised. Similarly, professional and academic institutions must apply
appropriate sanctions against corrupt HCPs and researchers.

HCPs
must be held accountable by professional associations. For example, the UK
General Medical Council (GMC) was accused of taking no action in 2012 when it
was given evidence that doctors were accepting incentives from private
healthcare facilities to give preference to its facilities to treat or refer
patients. Only after a later investigation by the Competition and Markets
Authority did the GMC write a warning to all licensed doctors.  The US should follow a similar process.

Current
leadership in the pharmaceutical sector is too weak and fragmented to address
corruption in a meaningful way. Systemic change will not be achieved by a small
number of individuals and organizations working independently. Strong,
purposeful leadership is needed at multiple levels and from a broad range of
people involved to create systemic change.

To
achieve anti-corruption progress in the pharmaceutical sector, as with all
sectors, it is essential that all actors display a strong obligation to action.
For governments, this will require a long-term political commitment to
addressing corruption, while for global institutions this means providing
strong assistance and direction to other actors. Overall, local, national and
international actors must collaborate to ensure anti-corruption efforts are
effective.

The
key actor to drive change in the sector is national governments. To genuinely
diminish corruption in the pharmaceutical sector national governments must show
commitment to tackling the issues that facilitate corruption. This includes
cleaning up the pharmaceutical sector by adopting a stance of no-impunity for
all corrupt actors in the pharmaceutical sector, including companies,
government officials and HCPs. Regardless of a company’s revenue, an official’s
seniority or a HCP’s prestige, anyone suspected of corruption must be
investigated and appropriate sanctions applied.

From
fines for guilty pharmaceutical companies being too low, to suspensions for
corrupt doctors not being issued, actors in the pharmaceutical sector are often
not being held accountable for committing corrupt practices. Low levels of
accountability result from insufficient performance monitoring, unclear laws
and regulations to punish corrupt behavior, inadequate resources to enforce
laws and regulations, and a lack of political and institutional commitment to
punish corrupt actors. Therefore, increasing accountability will mean
increasing the monitoring and evaluation of performance with efficient
information systems and the enforcement of sanctions for non-compliance with
laws and regulations.

While
the use of fines can be useful to combat corruption, its effectiveness on
deterring multinational pharmaceutical companies from engaging in corrupt behavior
has been debated. Strong evidence has shown that fines issued to pharmaceutical
companies by US authorities have been ineffectual. The level of fine a
pharmaceutical company pays in the United States is often a very small
percentage of the market share it has gained from the corrupt practices.

To ensure that fines do discourage pharmaceutical companies from engaging in
corrupt activities, the penalties issued by the authorities could be modified
to seek disgorgement of all profits generated from illegal conduct. As many
corruption cases occur when a pharmaceutical company has prioritized
profit-making over the needs of public health, a fine that impacts a company’s
bottom line should be extremely effective in countering corrupt practices, as
it removes the financial incentive.  

For
such policies to be adopted there must be strong leadership and political will.
Only with governments collaborating and global institutions providing clear
accountable oversight of the pharmaceutical sector, will it be possible to
introduce policies that mitigate institutional corruption. Civil society must
play its role in ensuring governments are transparent and accountable and
government officials must act with their population’s health as the number one
concern. Industry must use its knowledge and considerable resources as part of
multi- stakeholder initiatives that tackle corruption in the sector.

By taking a strong stance
on promoting transparency and fighting corruption, companies not only mitigate
reputational risk, but they also live up to their responsibility as corporate
citizens and can take an active part in the emerging solutions to some of the greatest
issues facing the world today.

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