Roy Poses on Corruption in Health Care

Roy Poses says that if you had asked Americans thirty or forty years ago whether American health care was corrupt, maybe two or three percent would say yes.


Now, it’s up over 40 percent.

There is a perception that health care is corrupt. Not as corrupt as the two political parties and not as corrupt as the media. But still, pretty corrupt.

And yet, doctors and medical societies don’t like to talk about it.

Roy Poses does. And he has set up a foundation to address the issue of corruption in health care.

It’s called the Foundation for Integrity and Responsibility in Medicine (FIRM).

Poses is a Clinical Associate Professor at the Alpert Medical School at Brown University.

And he’s master of the blog Health Care Renewal.

Poses says that doctors and healthcare groups don’t like to talk about corruption in their midst.

“The real reason it is taboo is that the topic makes people uncomfortable,” Poses told Corporate Crime Reporter in an interview last week. “The reason it makes people uncomfortable is that if you are in academic medicine or health care in the United States, the likelihood is that have – or you know somebody who at least has significant conflicts of interest — significant relationships with the healthcare industry while acting as an academic. Most people realize that it is not good to talk critically about such things because you will, at best, offend somebody you don’t want to offend.”

What about pharmaceutical industry sponsorship of drug studies?

“There have been a number of books that have touched on it. Hooked by Howard Brody. Money Driven Medicine by Maggie Maher. White Coat Black Hat by Carl Elliott,” Poses says.

“The company sponsors the study. The company controls how it is designed, run and disseminated. The company makes sure that so many decisions are made in a way that increases the likelihood that their product will look good. That means that most of the published studies that are commercially sponsored seem to favor the commercially sponsored product.”

“And if no measure they take is sufficient to make the product look good, they often make sure the study doesn’t see the light of day. All of that is pretty well documented. There are articles on how these studies can be designed, conducted and disseminated to favor the sponsor. One just came out by a guy named Tom Jefferson from the UK. He lists a catalogue of how you can manipulate the studies.”

“This whole enterprise of commercially sponsored studies of commercial products, drugs, devices, diagnostic tests, where the point is more marketing and getting the study approved by regulators, rather than finding out how well they work and what are the real benefits and real harms — you could say the whole system has implicitly become corrupt.”

“People are being bombarded by these reports and they become skeptical. Every now and then a real breakthrough comes along — but it’s hard to figure out what is real and what is not.”

“Many people might just become cynical and think – it’s all a lie and none of it is true.”

At the end of his talks to doctor groups, Poses gives advice from the past.

From Deuteronomy in the Old Testament:

“Do not pervert justice or show partiality. Do not accept a bribe, for a bribe blinds the eyes of the wise and twists the words of the innocent.”

From Matthew in the New Testament:

“No one can serve two masters. Either you will hate the one and love the other, or you will be devoted to the one and despise the other. You cannot serve both God and money.”

An Old English Proverb:

“He who pays the piper calls the tune.”

From Upton Sinclair:

“It is difficult to get a man to understand, when his salary depends upon his not understanding.”

He is not advocating that the medical profession be cut off from these big pharmaceutical companies or healthcare firms, is he?

“I have advocated that clinical trials on human beings not be sponsored by any corporations that stand to gain from the results. The clinical trials should be run at multiple arms lengths from the companies,” he says. “They should be run by academics and non profits with the companies having no influence over them. That would be a big change.”

“I have also advocated at times that physicians who make patient decisions should not have conflicts of interest that affect those decisions. Academics should not have conflicts of interest that affect their teaching. And that policy makers should not have conflicts of interest.”

“There is a 2009 report from the Institute of Medicine on conflicts of interest. They have some fairly strong proscriptions on conflicts affecting research. They say, except for extraordinary circumstances, nobody with conflicts should be running a clinical trial. And yet nobody has adopted even what the Institute of Medicine has recommended. There are recommendations from other groups that seem responsible and they have been ignored.”

Malcolm Sparrow at Harvard’s Kennedy School says 10 percent of every health care dollar is lost to fraud. He says it might be much higher.

“I once heard a health care policy expert who you have heard of say at a meeting that it is at least 10 percent fraud and probably 30 percent overall questionable payments.”

What can be done about health care fraud?

“I have an automatic Google search on fraud,” Poses says. “And just about every day, you will see some people busted, arrested, convicted, jailed for healthcare fraud. There is a lot of enforcement. I suspect that enforcement does at least deter or control fraud. But there is an important caveat. All of that enforcement has to do with local, small scale fraud. They do bust those people with regularity.”

“But when you have big fraud — say involving deceptive marketing of a blockbuster drug involving a large pharmaceutical corporation, people are not convicted of felonies and they don’t go to jail. Instead, there is some sort of legal settlement, which might be for what appears to be a lot of money to you and me anyway — hundreds of millions of dollars or more — but no person goes to jail. The people on whose watch the fraud occurred, or who ran whatever the scheme was, usually they pay no penalty. And presumably, by doing that fraud, the company increased their revenue, those people increased their bonuses, there was a personal gain. But there were no personal consequences. Nobody goes to jail. But you don’t even see people losing their jobs or pay a fine.”

[For the complete q/a format Interview with Roy Poses, see 29 Corporate Crime Reporter 44(12), December 16, 2015, print edition only.]

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