Transcript 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
“The [only] social responsibility of
business is to increase its profits.”
- Milton Friedman
Corporations
“Corporations [have] no moral conscience.
[They] are designed by law, to be concerned
only for their stockholders, and not, say,
what are sometimes called their
stakeholders, like the community or the
work force…”
-Noam Chomsky
Outline
 Corporate Domination of World Economy
 Corporate Taxation
 Corporate Crime
 Corporations and Education
 Corporations and the Media
Outline
 International Non-Cooperation and
Isolationism
 Case Studies
 Solutions
 Discussion
Corporations Dominate the Global
Economy
 Almost 6 million corporations
 90% of transnational corporations
headquartered in Northern Hemisphere
 500 companies control 70% of world
trade
 148 corporations control 40% of world’s
wealth (most are financial institutions)
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
 Apple is larger than Poland
The Stock Market
 The top 1% of Americans owns 35% 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)
The Stock Market
 Interesting Fact: As a group, U.S. Senators beat the
market by an average of 12% from 1993-98 (study
published 2004)
 The best fund managers average 3%
 STOCK (Stop Trading on Congressional
Knowledge) Act signed (2012):
 Removes loophole exempting Congressional lawmakers
and staff members from being prosecuted for “insider
trading” for using knowledge gained in their work
(political intelligence)
Congressional and Supreme Court Wealth
and Influence
 ½ of legislators are millionaires (vs. 1% of
U.S. citizens)
 Average personal fortune:
 Senator = $13 million
 Representative = $5 million
 All 9 Supreme Court justices hold over $1
million in personal net worth and sit
comfortably within America’s richest 2%
Corporations
Internalize profits
$2.1 trillion (U.S., 2013)
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); 17% for
corporations with assets over $10 million
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
 Tax breaks, corporate welfare, corporation-
friendly tax laws, loopholes, transferring
assets overseas
 Cities and states offer incentives to
companies to locate in their communities,
in exchange for the promise of jobs
 Companies often leave when a better offer
becomes available
Reasons for Inadequate
Corporate Taxation
 Incentives:
 Cash grants and loans
 Sales tax breaks
 Income tax credits and exemptions
 Free services
 Property tax abatements
 Highway and school construction
 $80 billion in 2011
 Income tax breaks - $18 billion
 Sales tax relief - $52 billion
Reasons for Inadequate
Corporate Taxation
 Cheating and under-payment common
 Auditing program understaffed and
underfunded
 1/3 high school students admits to
stealing something from a store in
the past year
Reasons for Inadequate
Corporate Taxation
 Offshore tax havens shelter capital
 Up to $32 trillion estimated (1/3 of all global
wealth)
 $11.5 trillion in individual wealth
 U.S. GDP = $16 trillion
 Cayman Islands:
 Population 150,000
 Home to 92,000 corporations
Reasons for Inadequate Corporate
Taxation
 83 of the largest 100 US companies have
subsidiaries in tax havens
 Lost annual tax revenue:
 $250 billion worldwide
 $100 billion in US
Ugland House, Cayman Islands
18,000 Corporations Registered Here
Job Creators?
“White Collar” (Corporate) Crime vs.
“Blue Collar” (Street) Crime”
 Each year in America, we lose;
 $3.8 billion to burglary and robbery
 Hundreds of billions to trillions of
dollars to white collar crime
Why So Much Corporate Crime
 Fines meager, often considered a cost of doing
business
 Corporate crime under-prosecuted, prosecutors
under-funded
 Confidential legal settlements keep important
public health and safety information secret
 May delay governmental intervention, cause
unnecessary morbidity and mortality
Corporate Crime
 Companies mandating forced arbitration
 SCOTUS allows corporate binding
arbitration contracts, limiting class action
lawsuits (AT&T v. Concepcion, 2011)
 Arbitration Fairness Act would counteract
ruling
Consequences of Corporatization
 Increasing industry
consolidation/mergers
 Inflation
 Rising unemployment
Consequences of Corporatization
 Rise of the “permatemp”
 Expatriation of jobs
 2000-2011: U.S.-based multinational
corporations cut 2.9 million jobs in U.S. while
increasing foreign employment by 2.4 million
 Overseas factories often lack adequate
occupational health and safety and
environmental standards
Consequences of Corporatization
 Decline in labor union membership
 Rise of workforce management
technologies (destabilize schedules,
turns employees into day laborers)
Political Spending
Corporations vs. Labor
 U.S. Chamber of Commerce spent $139
million on 2012 Congressional elections
 AFL-CIO and SEIU (two largest labor
unions) spend $6 million combined
Exorbitant CEO Pay
 Median U.S. CEO salary (for S and P 500
corporations) = $11.7 million (2014)
 CEO salaries up 997% since 1978
 Average worker pay up 11%
 “Performance pay” loophole allows
corporations to skirt $30 billion/yr in taxes
Exorbitant CEO Pay
 The average CEO makes 373X the salary of
the average U.S. worker (1960 - 41X)
 Mexico 45:1
 Britain 25:1
 Japan 10:1
 US Military: 20:1 (top rank : lowest rank)
 US ratio of average CEO to minimum
wage worker = 774:1
CEO Personality Characteristics
 Some data suggest certain traits common among
psychopaths are also commonly found in CEOs
(and politicians, world leaders, and serial killers):
 Grandiose sense of self worth/narcissism
 Persuasiveness
 Superficial charm
 Ruthlessness
 Lack of remorse
 Manipulation of others
The Mega-Rich
 Worried / Investing in personal security
 Bodyguards
 Armored cars
 Bullet-proof windows; machine gun proof doors
 Home security fogs
 Panic rooms
 Fully-stocked home medical suites
 Yachts with escape submarines
 Islands
Minimum Wage ≠ Living Wage
 Federal minimum wage = $7.25/hr
 18 states and DC have higher minimum
wages (Oregon = $9.10/hr, 2014)
 $10,423/yr for full-time job
 Real value down 42% compared with 1968
 Inadequate to pay rent, buy food and
clothing
Minimum Wage ≠ Living Wage
 Increasing to $9.25/hr on Jan 1, 2015
 Movements supporting $15/hr (still
inadequate)
 Over ½ of nation’s basic public
assistance funds go to working families
(substitute for benefits, therefore, taxes
support corporations)
Living Wage
 Over 140 municipalities have adopted living wage
laws
 Including NY, LA, SFO, Seattle, Chicago, and
Philadelphia
 10 states have passed pre-emptive laws forbidding
cities and counties from raising the minimum
wage
 True living wage at least $15/hr.
Corporate
Involvement in
Education
Would You Sign a Petition to Ban
Dihydrogen Monoxide?
1. It can cause excessive sweating and vomiting
2. It is a major component in acid rain
3. It can cause severe burns in its gaseous state
4. It can kill you if accidentally inhaled
5. It contributes to erosion
6. It decreases effectiveness of automobile brakes
7. It has been found in tumors of terminal cancer
patients
Geographic/Scientific Ignorance,
Pseudoscience
 Percent of US teens unable to locate
the following on a map:
 United States – 11%
 Pacific Ocean – 29%
 Japan – 58%
Pseudoscientific Beliefs
Percentage of Americans who believe “at least to
some degree” in these “phenomena”
 Astrology
 UFOs
 Reincarnation
 Fortune-Telling
1997
37%
30%
25%
14%
1976
17%
24%
9%
4%
Ignorance/Pseudoscientific Beliefs
 Half of US citizens do not believe in evolution and
many believe that humans and dinosaurs coexisted
(2007)
 40% think scientists still generally disagree
about evolution
 Only 12% of U.S. Protestant pastors believe in
evolution
 70% believe in global warming
Pseudoscientific Beliefs
 37% believe places can be haunted (2007)
 25% believe in UFOs (2007)
 24% believe in astrology (2009)
 16% believe that people with the “evil eye”
can cast curses or harmful spells
 14% have consulted a psychic or fortune
teller (2009
Ignorance/Pseudoscientific Beliefs
 22% of Americans don’t know whether an atomic
bomb has ever been dropped (2000)
 20% of Americans don’t know the earth revolves
around the sun (1999)
 18% believe in Bigfoot and the Loch Ness Monster
(2007)
 8% of men / 18% of women believe in astrology and
fortune tellers (2007)
Public Education in Disarray
 U.S. Schools ranked lowest among western nations
 ¼ of Americans functionally illiterate
 Some states require instructors to teach “creation
science,” “intelligent design,” and “climate change
skepticism”
 Despite politicians’ statements, 72% of
Republicans believe global warming is occurring
(92% of Democrats)
Public Education in Disarray
 Inadequate funding, decaying
infrastructure
 National HS graduation rate 65-70%
 No change from 1970s
 Lower incomes youths 6X as likely to
drop out
Public Education in Disarray
 College tuition costs rising
 Increasingly marginalizes poor, minorities
 70% of students come from wealthiest ¼
of US families
 14% from the poorest half
 But 39% of highest-achieving students
from poorest half
Legislative Mandates
 Bills allowing teaching of creationism
or “intelligent design” alongside
evolution
 Bills requiring global warming to be
taught as a “theory”
Anti-Science Legislators
 Members of the House Science Committee (2012)
 Paul Broun (R-GA): Evolution, embryology, and the Big
Bang Theory are “lies straight from the pit of hell;”
climate change is a “hoax”
 Ralph Hall (R-TX): Agrees with TX Governor Rick Perry
that climate scientists are involved in a conspiracy to
receive research funding.
 Jim Sensenbrenner (R-WI): The science on global
warming is “inconclusive”
Anti-Science Legislators
 Members of the House Science Committee (2012)
 Todd Akin (R-MO): “If it’s legitimate rape,”
women will not get pregnant (lost 2012 election)
 Dana Rohrbacher (R-CA): Claimed an earlier
period of global warming may have been caused
by “dinosaur flatulence,” suggested that if global
warming is real it could be addressed by cutting
down trees, does not believe that CO2 is a cause
of global warming
Nation’s Schoolchildren Call For Cuts in
Math/Science Funding
Benefits of Education
 For every $1 spent on early childhood
education, up to $17 are saved from
increased school achievement,
improved health, reduced crime, and
reduced reliance on public assistance
 Income increases 11% for every year of
education
Benefits of Education
 College graduates live 5 years longer
than high school dropouts
 Eliminating educational inequities
would have saved 8X as many lives as
medical advances from 1996-2002
Television and the Media
 The average American youth spends
900 hrs/yr in school, 1,500 hrs/yr
watching TV
 By age 65, the average American will
have spent 9 yrs watching TV
Corporate PR Tactics
 Advertising
 “The art of convincing people to spend money they don't
have for something they don't need.“ (Will Rogers)
 Astroturf - artificially-created
grassroots coalitions
 Corporate front groups
 Corporate espionage: spying, bribes
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
 Host all-expense paid educational seminars
for federal judges
Public Relations
$200 billion industry
PR flacks now outnumber
journalists
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”
Sponsored Environmental
Education Materials (Examples)
 American Coal Foundation’s “Power from
Coal”:
 “The earth could benefit rather than be
harmed from increased carbon dioxide.”
 National Potato Board’s “Count Your Chips”
computational skills curriculum
Textbook Publishers Facilitate
Corporate Messaging
 Scholastic, Inc.
 World’s largest publisher of children’s educational
materials

Found in 90% of U.S. classrooms
 Has taken money from Big Coal, Disney, Microsoft,
Nestlé, and Shell to produce books and lesson plans
 2011: Announces plan to terminate some industry
contracts, set up quasi-independent review board to
review corporate materials
Academics/Professional Organizations
Affected
 Increasing corporatization of academia
 For-profit schools
 Charter schools
 Educational corporations
Academics/Professional Organizations
Affected
 ↑Private commercial funding of university
research
 Front-end domination and rear-end
repression affect research agenda,
dissemination of knowledge
 Undone science
 Secrecy/gag clauses
 Corporate-sponsored harassment of
scientists
Academics/Professional Organizations
Affected
 For-profit colleges growing, marked by
corruption, high interest rates on loans
to the un- and under-qualified
 Student loan debt almost $2 billion
one decade ago, now $1.2 trillion

Greater than all Americans’ credit card
debt
 Benefit largely from taxpayer money
Academics/Professional Organizations
Affected
 Dramatic decrease in tenured faculty, rise in
administrators
 75% of faculty members now adjunct
 2001 – 2011: Number of published papers increased
by 44%; number of retracted articles increased 15fold (3/4 for errors, ¼ for fraud)
 Gagging of researchers at federal agencies
demoralizing, can affect recruitment of quality
scientists
Union of Concerned Scientists (2015)
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
 Approximately 40,000 lobbyists (11,781 full-
time)
 Estimates of return on lobbying range from
$28 to $212 for every $1 spent (higher values
more likely
 Return on campaign contributions for
elections for the most politically active
companies = $760 per $1 spent
Lobbying
 Federal lobbying groups spent $3.2
billion in 2014
 All single issue ideological groups
combined (e.g., pro-choice, antiabortion, feminist and consumer
organizations, senior citizens, etc.)
spent well under $100 million
Top-Spending Industries, 2014
 Pharmaceutical industry - $230 million
 Business Associations - $163 million
 Insurance industry - $151 million
 Oil and gas industry - $141 million
 Computers/Internet - $140 million
 Electric utilities - $122 million
Lobbying/Campaign Contributions
 Koch brothers spent over $400 million
 All single issue ideological groups combined
(e.g., pro-choice, anti-abortion, feminist and
consumer organizations, senior citizens,
etc.) = $76.2 million
 Lobbying promotes international noncooperation/isolationism
Lobbying
 SCOTUS’ Citizens United and
McCutcheon v. Federal Election
Commission decisions have opened the
floodgates for unlimited corporate
contributions
 196 donors contributed nearly 80% of
money raised by super-PACs in 2011
The Decline of Democracy
 True democracy demands an informed
citizenry (education), freedom of the
press (media), and involvement (will,
time, money)
 Democracy is critical to the success of
public health
Corporations and International
Agreements
 Corporations attempt to influence writing
and acceptance/rejection of international
agreements
 Through misinformation, lobbyists,
revolving door between industry and
government
 Large behind the scenes role
International NonCooperation/Isolationism
 Failure to sign or approve:
 Kyoto Protocol on Climate Change
 International Covenant on Economic,
Social, and Cultural Rights
 Convention on the Prohibition of AntiPersonnel Land Mines
International NonCooperation/Isolationism
 Failure to sign or approve:
 Treaty to ban cluster bombs
 Convention on the Rights of the Child
 Convention on the Elimination of
Discrimination Against Women
 UN Declaration of the Rights of
Indigenous Peoples
International NonCooperation/Isolationism
 Failure to sign or approve:
 WHO Code of Conduct for Marketing
Breast Milk Substitutes
 Convention for the Suppression of Traffic
in Persons
 The Stockholm Convention on Persistent
Organic Pollutants
Worldwide Health and Social
Justice: Can Aid Help?
 In total dollars: U.S. #1
 As a % of GDP, U.S. ranks 21st among
the world’s wealthiest nations
 U.S. Aid: Over 1/3 military, 1/4
economic, 1/3 for food and
development
 Most U.S. aid benefits U.S.
corporations
Foreign Aid
 0.19% of the total federal budget, vs.
UN target of 0.7%
 Americans think that 28% of the
federal budget goes toward foreign
aid
 Corporations involved in massive land
grabs in developing nations
Case Studies
The alliance between GE
Medical Systems and NYPresbyterian Hospital
Martin Donohoe
The Partners
 NY-Presbyterian Hospital
 one of the largest academic health
care institutions in the U.S.
 GE Medical Systems (now GE
HealthCare)
 Subsidiary of General Electric
 $9 billion annual revenues
The Agreement (2003)
 10-year, $500 million agreement
requires NYP to purchase products and
services from GEMS in exchange for
purported discounts on medical
supplies and the promise of enhanced
technological standardization and
simplification
General Electric
 Ranked by Forbes as world’s largest
company (based on equal weighting of sales,
profits, assets, and market value)
 2014 revenues of $149 billion
 Close to the GDP of more than 2/3 of U.N.
member states
2014 net after-tax profits of $15.2 billion
 Majority from overseas operations
General Electric
 Makes household appliances, lighting,
and medical equipment
 Plastics division, which produced
bisphenol A, spun off in 2008
 Produces jet engines and military
hardware
GE’s History
 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
 Has built 91 nuclear power plants in 11
countries (including the troubled
Fukushima Daishi plants in Japan)
 Including 23 plants at 11 sites in U.S.
 e.g., Hanford
 ¼ of GE’s US reactors found to be
defective
General Electric
 Operates coal-burning power plants
 Major releasers of toxic mercury
 Produces nearly 40 technologies used in
fracking
 Increasing investments in fracking
General Electric
 Operates a large financial services group
 Responsible for over 50% of company’s profits in recent
years
 2015: company plans to sell off majority of GE Capital
(now Syncrhony Financial) over next 2 years
 Under investigation by the Justice Department for over
potential bankruptcy violations
General Electric
 Until recently, owned 49% of a multi-
billion dollar media empire
 Including NBC, Telemundo, and
Universal Studios
 Comcast owned 51%; bought out GE
in 2013
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
 May have contributed to increased thyroid cancers,
hypothyroidism, and spontaneous abortions in
“Downwinders”
GE’s Record
 Sued radiologist who brought to light dangers of GE’s
contrast agent, Omniscan
 Causes nephrogenic systemic fibrosis (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 at least 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
 Has spent millions to avoid Hudson cleanup
and to weaken or eliminate Superfund Law
 Contributes to corporate front groups
 Promulgate an anti-scientific and pseudoscientific agenda
 Conduct media disinformation campaigns
in an attempt to weaken health and
environmental regulations
GE’s Record
 Tremendous influence of environmental,
energy, and health policy
 Spent over $16 million on lobbying in 2014
 More than $200 million over last decade
 Many members of board of directors have
government ties; others have insurance and
pharmaceutical industry ties
GE’s Record
 Eliminated 150,000 jobs in last 15 years
 While receiving billions in federal
contracts and millions in state and local
subsidies
 One of nation’s top out-sourcers of jobs
 1/5 of U.S. workforce eliminated since
2002 (while overseas workforce increased)
GE’s Record
 Eliminated 34,000 US jobs between
2000 and 2010
 Added 25,000 overseas jobs over same
period
GE’s Record
 Executive pension plan far more
generous than for other employees
 Continues to shift health care costs
onto workers, despite growing profits
GE’s Record
 Cited by Human Rights Watch for
“systematic workers’ rights violations”
in the U.S. and abroad
 858 OSHA workplace citations from
1990-2001
 Investments include for-profit prison
enterprises
GE’s Record
 GE has sponsored PGA Masters
Tournament at Augusta National Golf
Club
 Club excludes women
 CEO Immelt a member
GE’s Record
 Topped 2002 Project on Government Oversight’s
list of repeat offenders for defrauding U.S.
taxpayers
 Paid more than $982 million in fines,
judgments, and out-of-court settlements
between 1990 and 2002
 Financial services division fined $100 million for
unfair debt collection practices and bankruptcy
court malfeasance
GE and Corporate Taxes
 GE topped the list of corporate tax break recipients
from 2001-2003:
 $9.5 billion in tax breaks
 Claimed tax benefits of $3.5 billion in 2010 ($4.1
billion tax benefits on $26 billion in American
profits between 2006 and 2010)
 Under investigation for tax evasion in Brazil
 Tax department has almost 1,000 employees
(known as the “world’s best tax law firm”)
GE’s Record
 In 1990s, Pentagon’s Defense Contract
Management Agency created special
investigations office specifically for GE
 Nevertheless, company has been
awarded increasingly costly
reconstruction contracts in Iraq and
Afghanistan
GE’s Record
 The Patient Channel
 Shown in hospital rooms throughout
country
 Advertising vehicle for drug
companies
 Criticized by JCAHO for
manipulative marketing practices
GE’s Record
 Produces an electronic medical record,
Centricity EMR
 Is hoping to receive some of the $19
billion earmarked for health care
information technology in the current
economic stimulus package.
GE CEO Jeffrey Immelt
 2014 total compensation = $37.2 million
(up from $25.8 million in 2013)
 Named “World’s Best CEO” in 3
separate Barron’s polls
 2006 - 2011 - On Board of NY Federal
Reserve Bank
GE CEO Jeffrey Immelt
 2008 – Named one of the “100 Most Influential
People in the World” by TIME Magazine
 2009 - Appointed by President Obama to his
Economic Recovery Board
 GE then became eligible, via a loophole, for ¼ of
the $340 billion Temporary Liquidity Guarantee
Program (debt support)
GE CEO Jeffrey Immelt
 2011 - Appointed by Obama as Chair of
his outside panel of Economic Advisors
and of his Council on Jobs and
Competitiveness
GE CEO Jeffrey Immelt
Charitable works include
membership on the board of
directors of “The Robin Hood
Foundation”!
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
 Occured at time when 41 million
Americans uninsured
 Academic medical centers promoting
luxury primary care clinics and seeking
wealthy overseas patients while cutting
back on services to the un- and underinsured
Concerns About the Agreement
 Academic medical centers becoming
increasingly corporatized
 Research exclusivity contracts
 Secrecy
 gag clauses
 skewing of research agenda
Concerns About the Agreement
 I contacted the CEO of New York
Presbyterian Hospital and the head of
the Ethics Department to obtain more
information re the agreement and the
nature of the discussion preceding the
agreement
 No Response
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”
Background
 2007: Essay describing health and
environmental consequences of global
warming for Medscape
 Described ACSH as a corporate front
group and criticized its selection of
author Michael Crichton as recipient of
its 2005 Sound Science Medal
ACSH and Global Warming
 Leader referred to “belief” that burning
fossil fuels has caused global warming
as pseudoscience
 Criticized environmental scientists as
“doomsayers” and “fearmongers”
ACSH Response
 Threatened litigation against
Medscape
 Medscape briefly pulled article, then
published with comments removed,
then republished with additional
material
 ?Loss of potential readership?
Dr Elizabeth Whelan:
Former president and co-founder (d. 2014)
 Early writing career included:
 Freelance writing assignment for
Pfizer criticizing the FDA
 Consumer magazine pieces
 Books include Panic in the Pantry
and Toxic Terror
 Whelan’s 2003 salary = $326,612
Dr Gilbert Ross:
Medical/Executive Director
 Spent 1996 in federal prison after being
sentenced to 46 months for
 Medicaid fraud
 Perjury
 Obstruction of justice
 Not mentioned on his bio on ACSH
website
ACSH:
Dr Gilbert Ross’ Career
 Barred by the DHHS for 10 years from
participating in either Medicare or
Medicaid
 Now in charge of all scientific projects,
publications, and personnel issues
involving scientific staff at ACHS
ACSH
 ACSH Board of Directors includes anti-
regulatory Individuals (2001 Survey)
 George Lundberg, former editor of JAMA,
current editor of Medscape, on board of
advisors
 Funding from right wing foundations,
corporations
 Accepted money to write and disseminate
pro-industry “studies”
Corporate Front Groups
 Promote corporate agendas
 Strong financial and advisory links
with corporations
 Disseminate misinformation/lies under
guise of “science”
 Promote pro-business, conservative
ideology
ACSH:
Pseudoscience and Misinformation
 Attacked the precautionary principle
 “anti-science,” “elitist,” and
“theology”
 Minimized the effects of
environmental tobacco smoke (ETS) on
human health
 40,000 deaths/yr in U.S.
ACSH:
Pseudoscience and Misinformation
 Denied many of the adverse neurological effects of
lead exposure
 Denied endocrine-disrupting effects of PCBs
 Claimed court ordered-cleanup of Hudson River
by GE based on false claims of PCBs causing
cancer
 Claimed uncertainty regarding effects of
agricultural antibiotics on food-borne, antibioticresistant human infections
ACSH:
Pseudoscience and Misinformation
 Called warnings regarding tuna consumption by
pregnant women “unfounded health scare”
 Critiqued health concerns re trans fatty acids
 “There is no such thing as junk food”
 “There is insufficient evidence of a relationship
between diet and any disease.”
ACSH:
Pseudoscience and Misinformation
 Claimed “irradiated food is safe, wholesome
and nutritious” and “no radioactive isotopes
are involved”
 Denied link between dioxins and pesticides
and adverse health effects
 Supported use of human volunteers in
pesticide toxicity studies
“Phony Health Scares”
 Flame retardant traces found in blood
and breast milk
 Diesel exhaust fumes from school
busses
 Arsenic in drinking water
 Phthalates in medical devices and
children’s toys
ACSH: Attacks on Scientists and the
Scientific Enterprise
 Threat of litigation against Medscape
antithetical to the rules of science
 requires the free exchange of
information and opinion in pursuit of
the truth
ACSH: Attacks on Scientists and the
Scientific Enterprise
 ad hominem attacks
 environmentalists = “toxic terrorists”
 Whelan criticized Dr. Barry Levy and
citizen-activist Erin Brockovich
Implications of Attacks on Science and
Scientists
 ACSH has broad media presence
 Web site attracts large numbers of
individuals
 100,000 hits per month for 2005
 Dr. Whelan has been featured on NBC’s
Today Show, CNN Live, and CNBC’s
Business Insiders
Implications of Attacks on Science
and Scientists
 Editorials by Whelan and Ross have
appeared in the New York Times and
Wall Street Journal
 Publications in Medscape, other
journals
Implications of Attacks on Science and
Scientists
 Mislead public
 May cause alterations in lifestyle and/or
purchasing habits
 Adverse health consequences
 Threats of litigation distract, intimidate, and
deplete the scientific, legal, and financial resources
of individuals and groups committed to public
health
Implications of Attacks on Science and
Scientists
 Faulty pronouncements influence
elected officials
 Threats of litigation divert the valuable
time of health care providers, editors,
and legal departments away from more
productive missions of research,
teaching, writing, and patient care
Implications of Attacks on Science and
Scientists
 Scientists and health care advocates
may decide it is wiser to avoid conflict
than publish content to which ACSH
and other such groups might object
Other Examples of
Corporate Meddling in
Public 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 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
 Law struck down by courts
Drug Testing
 Florida Governor Rick Scott
 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
Corporate Structure of American Board
of Internal Medicine
 Annual budget over $50 million
 Lobbied Congress to ensure that
physicians participating in
Maintenance of Certification through
ABIM eligible for incentive payment
under ObamaCare
Corporate Structure of American Board
of Internal Medicine
 CEO Richard Baron’s 2010 salary = $800,000
 Salary determined by Board of Directors
 Baron: “If they were trying to hire
somebody to do this job, what other job
would they be doing and what would
people in comparable organizations be
paid”
Corporate Structure of American Board
of Internal Medicine
 Controversies surrounding
Maintenance of Certification
 Utility and cost
 Alternatives (e.g., National Board of
Physicians and Surgeons)
Medical Care
 Sponsor luxury care consortiums,
clinics
 Facilitate medical tourism
 Participation in “medical transfer
market” (facilitates medical
repatriations of undocumented
immigrants - e.g., MexCare)
Health Insurance Industry
 Dubious practices:
 Delisting
 Cherry picking
 Pre-existing conditions
 Limiting coverage of medications for high cost
illnesses
 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
 Only 10% of new drugs treat life-
threatening conditions
 90% of new drugs little or no better
than pre-existing agents (or cause
harm)
 Thus only 1% of new drugs “life-saving”
Pharmaceutical Industry
 Pay-for-delay costs consumers and
taxpayers $3.5 billion in additional drug
costs/yr
 Over 40,000 drug-related deaths not
reported to FDA, as required, over last
decade
Pharmaceutical Industry
 Influence over physicians through control of
CME, gifts, research funding
 Over $3.7 billion to at about 366,000
physicians and 900 teaching hospitals in
2014 (excluding research funding)
 Physician Payments Sunshine Act –
reporting requirements
Pharmaceutical Industry
 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
 Unethical trials in developing world
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%
 Has paid out almost $20 billion in civil and
criminal penalties over the last 20 years
Pharmaceutical Industry
 Avoided $7 billion in US taxes in 2012 by
shifting profits overseas
 $230 million dollars spent on lobbying in
2011
 2.3 lobbyists for every member of
Congress
 Revolving door between legislators,
lobbyists, executives and government
officials
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
 Patent extensions
Pharmaceutical Industry
 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
 Poor compliance with Clinical Trials
Registry rules
Pharmaceutical Industry
 Promotion of agricultural antibiotic overuse
 Pharmaceuticals in the Developing World
 Up to 30% poor quality due to:
Improper manufacturing
 Degradation due to age or poor storage
 Counterfeiting by rogue factories

PPACA (Obamacare)
Patient Protection and Affordability Care Act
 Career arc of Elizabeth Fowler (architect of plan):
 VP for Public Policy and External Affairs
(informal lobbying) at WellPoint (nation’s
largest insurer)
 Chief health policy counsel to Senator Max
Baucus (who drafted legislation)
 Head of Global Health Policy at pharmaceutical
giant Johnson and Johnson
Breast Milk Substitute Manufacturers
 Marketed to women in developing world
 Nestlé, others
 Discourage (and make more difficult) breast
feeding
 WHO International Code of Conduct
 U.S. has not signed
 91% of U.S. hospitals distribute formula
packs (which would violate WHO code)
Chemicals Industry
 Chisso Corporation
 Methylmercury poisoning
 Minimata Disease
Minimata Disease
W Eugene Smith
Energy Industry
 Oil and gas, coal, fracking, nuclear power
 Sponsorship of faculty, training programs
 Funding research and policy papers
 Lobbying
Solutions
 Restructure tax system
 Decrease taxes on work and savings
 Increase taxes on wealthy
 Maximum income (France, England
considering)
 Increase capital gains tax from 15% to
(at least) prior 25% rate
Solutions
 Restructure tax system
 Resume transaction tax on stock
sales/purchases
 Increase taxes on destructive activities
(e.g., carbon emissions, toxic waste
generation)
 Improve regulation of banks (e.g., enforce
Dodd Frank law)
Solutions
 Punish corporate scofflaws with large fines and jail
time
 Hide no Harm Act (pending in Senate) would
hold corporate officers criminally accountable if
they knowingly concealed serious dangers that
led to consumer or worker deaths or injuries
 Increase enforcement budgets to combat corporate
crime
Solutions
 Eliminate confidential legal settlements and
confidential business information relevant
to public health and safety
 Eliminate mandatory binding arbitration
clauses
 Living wage laws
Solutions
 Work with corporations
 Benefit corporations
 Healthy PR
 Shareholder activism
 Risks/benefits
Solutions: Fair, Representative Elections
 Publicly financed campaigns and campaign
finance reform
 Members of Congress spend between 30%
and 70% of their time fundraising
 50% of Senators and 42% of
Representatives become lobbyists after
leaving office
Solutions: Fair, Representative Elections
 Open debates, free air time for candidates
 Proportional representation
 Instant runoff voting/cumulative voting/range
(rating) voting
 Halt disenfranchisement, overturn voter
restriction laws
Solutions: Vote
 US voter turnout low
 Wealthy vote at almost twice rate of
poor
 Whites > Blacks > Hispanics
 Old > Young
 Property owners > Renters
 Physicians < general population
Voter Turnout
Voter Turnout
 Average senator = 62 yo
 Average representative = 57 yo
 Increased voter turnout by marginalized groups
likely to lead to a younger, more progressive
Congress
 Limiting incumbency would also help
(incumbents have a huge advantage in elections)
Solutions
 Activism / Letter writing / Protesting /
Whistleblowing
 SCOTUS sharply restricted public
employees’ whistleblowing rights in
Garcetti v. Ceballos (2006)
 But, Congress passed Whistleblower
Protection Enhancement Act (2011)
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
Air Pollution
Factory Farming
Global Warming
Famine
Discretionary Federal Spending (2013)
World Military Spending (2012)
Solutions
 Based on Precautionary Principle
 Recognize nature’s net worth
 Calculate prosperity based on Genuine
Progress Index or Global Happiness
Index, rather than Gross Domestic
Product
“All men are created equal”
Declaration of Independence
“Some people are more equal
than others”
George Orwell
Voltaire
“The comfort of the rich rests
upon an abundance of the poor”
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.”
Alice Walker
“The most common way people
give up their power is by thinking
they don’t have any”
African Proverb
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.org
[email protected]