We have noted the paucity of organized efforts to combat health care corruption and related phenomena. What efforts exist tend to focus on corruption elsewhere, as if no one is willing to admit it can occur in their back yard. Now one organization that has made some efforts in this sphere is closing, and another will explicitly focus its efforts on problems elsewhere.
International Council on Human Rights Policy Closes
The ICHRP was located in Geneva. It had a wide focus, but was willing to consider how corruption could affect human rights. Its publication, Corruption and Human Rights: Making the Connection, explicitly noted the threat of corruption to the right to health. (Note that in international policy, this right is not considered to be to unlimited health care, but to "attainment of the highest available standard of physical and mental health.") It went on to list a variety of ways in which government corruption, or corruption of health care leaders or organizations outside of government could harm health. (Full disclosure: I participated in a meeting the IHCRP convened to review a draft of this publication.)
Now, as announced in the IHCRP blog, the IHCRP will close at the end of this month:
The decision to close was taken by the Executive Board primarily due to continued financial difficulties, largely a result of the difficult funding climate, especially for human rights and even more so for human rights policy research. It is especially regrettable because for more than a decade the ICHRP stimulated co-operation and exchange across the non-governmental, governmental and inter-governmental sectors, and strove to mediate between competing perspectives.
Healthy Skepticism in the Netherland to Only Focus on Problems "Abroad"
Today I got a press release (as of 21 February available here) from the Dutch Institute for Rational Use of Medicine (IVM), that stated:
The Dutch Institute for Rational Use of Medicine (IVM) is changing the course of its renowned Healthy Skepticism programme, which has critically monitored the pharmaceutical industry’s impact on the use of medication over the past ten years. Healthy Skepticism will be shifting attention away from its activities in the Netherlands, choosing to focus instead on supporting initiatives abroad.
The immediate reason seemed to be lack of funding, like the reason advanced for the closing of the ICHRP:
The change is prompted by the fact that the Dutch Ministry of Health, Welfare and Sport has eliminated funding for the programme....
The announcement first suggested that the change of focus came about because the initiative had attained its original goals:
another factor is the radical change that has occurred in the pharmaceutical industry’s attitude and conduct over the past decade.
Commenting on the change, IVM director Ruud Coolen van Brakel stated: 'Although there are still some problem areas, overall the industry has become more mature and more responsible’.
However, later in the announcement the implication was stronger that this lack of funding may have resulted from how the program challenged the powers that be, perhaps those who were personally profiting the most from the status quo:
The impact of Healthy Skepticism’s initiatives has not been unequivocally positive. IVM met with considerable resistance, which at times even became personal, and, because of its critical attitude, often became the target of aggressive attacks that also compromised its funders, the Ministry of Health, Education and Sport and the Healthcare Inspectorate.
We noted most recently (here, December, 2011) most of the organizations one might have expected would have provided some response to health care corruption instead have largely treated it as at best a nuisance. Specifically, there is almost no teaching or research on corruption in health care academics (including medical and public health schools, and programs in health care research and policy.) There is almost no mention of corruption by health care professional associations. There are almost no initiatives to fight corruption on the part of health care charities and donors. There is almost no interest in corruption among patient advocacy organizations. (See previous discussion here.)
Furthermore, I also postulated that at least in the US context, this lack of interest in corruption may partially be explained by these organizations' institutional conflicts of interest and the individual conflicts of interest affecting their leaders. It may be further explained by the exposure of some leaders to the irresponsible, if not amoral culture that now currently pervades finance, which may have in turn been one cause of the great recession, or global financial collapse.
The ICHRP and the Dutch Healthy Skepticism program seemed to be happy exceptions. However, both of them depended on outside government or non-profit organizations for funding. In both cases, these outside funders seem to have lost enthusiasm, maybe for reasons discussed above.
At least the ICHRP archives remain available, and Dutch Healthy Skepticism may be able to make some useful contribution outside the Netherlands.
There is increasing evidence that health care corruption may end up killing people. I still hope that the courage of those who have tried to increase awareness of health care corruption, the conflicts of interest that can increase its likelihood, and surrounding phenomena, will not be in vain. I still hope that some academic health care institutions, professional societies, health care charities and donors, and patient advocacy groups will gain enough fortitude to stand up for accountability, integrity, transparency, and honesty in health care.