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

Martin Donohoe

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”

Corporations Dominate the Global Economy

Almost 6 million corporations90% of transnational corporations

headquartered in Northern Hemisphere

500 companies control 70% of world trade

Corporations Dominate the Global Economy

• 53 of the world’s 100 largest economies are private corporations; 47 are countries

–Wal-Mart is larger than Israel and Greece

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)

Corporations

• Internalize profits

• Externalize health and environmental costs

Corporate Taxation

• Corporations shouldered over 30% of the nation’s tax burden in 1950 vs. 8% today• Nearly 1/3 of all large U.S.

corporations pay no annual tax

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)

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

Reasons for Inadequate Corporate Taxation

• Corporate tax breaks/loopholes

• Corporate welfare

• Cheating and under-payment common

• Offshore tax havens shelter capital

Ugland House, Cayman Islands18,000 Corporations Registered Here

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 45:1–Britain 25:1–Japan 10:1

Corporate PR Tactics

• Advertising• Astroturf - artificially-created grassroots

coalitions• Greenwash• Corporate front groups

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

Greenwash

• Public relations / ad campaigns–BP invests $100 million annually in

clean energy = amt. it spends annually to market itself as moving “Beyond Petroleum”

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”

Exxon’s “Energy Cube”-“Gasoline is simply solar power hidden in decayed matter”-“Offshore drilling creates reefs for fish”

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

The Media

• 5 corporations control majority of US media (down from 50 in 1983)

• Extensive corporate-media links

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 2004;306:1686-7(Study covers 1993-2003)

Lobbying

• Over 15,000 full-time lobbyists

• Estimates of return on lobbying range from $28 to $100 for every $1 spent

Lobbying

• Lobbying groups spent 3.5 billion in 2010 (federal lobbying, a record)

• All single issue ideological groups combined (e.g., pro-choice, anti-abortion, feminist and consumer organizations, senior citizens, etc.) = $76 million

• Lobbying promotes international non-cooperation/isolationism

Case Studies

The alliance between GE Medical Systems and NY-Presbyterian

Hospital

General Electric

• Ranked by Forbes as world’s largest company (based on equal weighting of sales, profits, assets, and market value)

2010 net after-tax profits of $14 billion$5.1 billion in U.S.

General Electric

• Makes household appliances, lighting, and medical equipment

• Has built 91 nuclear power plants in 11 countries (including Japan’s troubled Fukushima Daishii reactors)

• Produces jet engines and military hardware

General Electric

• Charles Wilson (CEO of GE pre- and post-WW II; helped oversee U.S. military production during WW II):– “The revulsion against war…will 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.”

General Electric

• Operates coal-burning power plants– Major releasers of toxic mercury

• Operates a large, highly profitable financial services group – Responsible for over 30% of revenue and 50% of profits in

recent years

• Owns a multi-billion dollar media empire– Including NBC (49%, Comcast – 51%), Telemundo,

and Universal Studios

GE’s 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

GE’s Record

• Sued radiologist who brought to light dangers of GE’s contrast agent, Omniscan– Causes nephrogenic systemic sclerosis (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 BD’s Isovue

GE’s Record

• America’s largest corporate polluter

• 116 Superfund sites nationwide

• Approximately 13 in NY

GE’s 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

GE’s Record

• CEO Jeffrey Immelt named “World’s Best CEO” in 3 separate Barron’s polls

• On Board of NY Federal Reserve Bank and appointed by President Obama to his Economic Recovery Board

GE’s Record

• Has eliminated 150,000 jobs in last 15 years• One of nation’s top out-sourcers of jobs• Cited by Human Rights Watch for “systematic

workers’ rights violations” in the U.S. and abroad

• Extensive record of tax violations, military procurement fraud

GE’s Record

• Named “America’s Most Admired Company” by Forbes• Named one of the “World’s Most

Respected Companies” in polls conducted by Barron’s and The Financial Times

Concerns About the Agreement

• Provides GE with financial incentives to promote high technology purchases

• Hospital prohibited from purchasing more effective equipment from other companies

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

Concerns About the Agreement

• Patients with developmental anomalies and cancers caused by GE’s pollution diagnosed with GE scanners and treated with GE-manufactured therapeutic devices, increasing GE’s profit

A macabre twist on “cradle to grave care”

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

Confronting Pseudoscience and Threats from a Corporate Front Group:

The American Council on Science and Health

WHO Tobacco Treaty

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

Medical Technologies Industry

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

Drug TestingDrug 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

Drug TestingDrug 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!

Corporate Agribusiness

• Successful campaign against Oregon’s Proposition 27 (labeling of GM foods)

• Lobbying for pre-emptive labeling laws re GMOs, rBGH

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

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

Medical Care

• Sponsor luxury care consortiums, clinics• Facilitate medical tourism• Niche in “medical transfer market,”

facilitating medical repatriations of undocumented immigrants (e.g., MexCare)

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)

Health Insurance Industry

• Large profit margins

• Loyalty: shareholders (not patients)

• Corruption

Prison-Industrial Complex

• Construction and management of prisons

• Providing (substandard) health care to inmates

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– Ok’d by SCOTUS in Sorrell v. IMS Health

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%

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

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

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

Solutions

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

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

Solutions: Vote

US voter turnout lowWealthy vote at almost twice rate of

poorWhites > Blacks > HispanicsOld > YoungProperty owners > RentersPhysicians < general population

Voter Turnout

Solutions• Activism / Letter writing / Protesting

/ Whistleblowing–Unfortunately, SCOTUS sharply

restricted public employees’ whistleblowing rights in Garcetti v. Ceballos (2006)

Solutions

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

Solutions

• Increase funding of public education

• Independent scientific review of school curricula

• Prohibit use of sponsored curricula

Solutions

• Establish safeguards re corporate involvement in academic research

• Higher standards of journalism

• Support alternative media

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

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

Solutions

• Augment and improve international aid package

• Sign, ratify, and adhere to major international treaties

• Support Millenium Development Goals

Solutions

• Based on Precautionary Principle• Recognize nature’s net worth• Calculate economic prosperity based on

Genuine Progress Index or Global Happiness Index, rather than Gross Domestic Product

Voltaire

“The comfort of the rich rests upon an abundance of the poor”

• “All men are created equal”–Declaration of Independence

• “Some people are more equal than others”–George Orwell

Hudson River, 2009

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.”

Günter Grass

“The first job of a citizen is to keep your mouth open.”

Anita Roddick

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

Contact Information and References

Public Health and Social Justice Website

http://www.publichealthandsocialjustice.org

http://www.phsj.orgmartindonohoe@phsj.org