Medical–industrial complex

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The medical–industrial complex is a network of interactions between pharmaceutical corporations, health care personnel, and medical conglomerates to supply health care-related products and services for a profit.^[1][2] The term is a product of the military–industrial complex and builds from the basis of that concept.^[3]

The medical–industrial complex is often discussed in the context of

Pharmaceutical companies are a leading influence in the expansion of the Medical-Industrial Complex.

Pharmaceutical companies also produce bias in physicians and other health care professionals.^[1] Research performed with pharmaceutical-company funding is more likely to produce favorable results that can extend to physicians who become more likely to promote their product.^[4] This suggests that pharmaceutical companies can produce bias in physicians and the studies that support physician's choices. These effects manifest in physicians, who are more likely to prescribe an expensive medicine over a generic alternative if they are familiar with the drug brand.^[20]

The medical-industrial complex funds continuing medical education that often has a bias to promote the interest of its funders.^[23] To continue practicing as a board-certified physician, which most hospitals require, a physician must take a continuing medical education course. Continuing medical education is a program that ensures physicians are up-to-date with recent medicine and programs, also giving them board certification if they pass the exam at the end of the course.^[24] These courses are often sponsored by pharmaceutical companies and healthcare corporations, who can instill bias in physicians.^[9] For example, if a course was sponsored by a medical device company, then the coursework and exam would reference using that medical device.^[1] When the course is completed, it is more likely that physicians will use that medical device when interacting with patients, which can present a clear conflict of interest.^[1][23] The medical device may be unnecessary in the patients treatment, undergoing efficacy research, or not the ideal device to use when treating a patient, which can all contribute to the unfair treatment of the patient. Understanding the medical device is also essential for the physician to pass the CME course, thus instilling bias further. This conflict of interest can affect how a patient is treated and how much they have to pay for their treatment.^[25] Hospital corporations that help fund these events also promote physician bias, where physicians are likely to recommend one hospital over another, where one hospital may be much more expensive than the other.^[26]

There are entities that work to reduce bias in continuing medical education courses. Groups such as the Accreditation Council for Continuing Medical Education work to make the program as unbiased as possible. Other groups like the Medical education agency^[27] work to reduce pharmaceutical and hospital influence in continuing medical education courses.^[27]

Consequences

The Medical-Industrial Complex poses unique difficulties for patients and physicians. Diseases like chronic illnesses can tie a patient further into the Medical-Industrial Complex for the rest of their life.^[28] Likewise, a terminal illness can force a patient to accept their soon passing, but also deal with the consequences of the illness and how they must pay for it.^[28]

For patients dealing with recent wide-spread diseases like COVID-19, treatment often comes with steep prices in Medicare and insurance. In recent 2020 health-care research, data has expressed how pandemics like COVID-19 have further tested the preparedness of the entire system's ability to combat a rapidly spreading virus.

Patient-level

A

For patients with a chronic illness, diagnosis often means expensive medications for the rest of one's life. Chronic illnesses like depression may require medications until the disease is treated, whereas more severe chronic illnesses like cystic fibrosis require expensive medical and pharmaceutical treatments for one's entire life.^[4][1] These diseases could be treated but their unique long-lasting nature means money can be generated from life-long treatments as opposed to an end-all treatment.^[1]

Individuals in low-income households and racial minority groups have experienced most of the impact of the Medical Industrial Complex during the pandemic as over one third of Latino adults or low-income adults were uninsured at some point during 2020.^[29] This led to racial disparities in COVID-19 deaths for African Americans. For example, African Americans accounted for a quarter of the deaths to COVID-19, while only making up 12% of the United States population.^[30]

Physician-level

Physicians are subjective to the Medical-Industrial Complex and its manifestations. Throughout the 21st century plastic surgery has become more common, where people have surgeries performed to solve a cosmetic issue.^[1] Cosmetic surgeries are often used to satisfy a certain beauty standard. An example of this is a rhinoplasty, which is oftentimes a purely cosmetic surgery that is not life-saving or necessary for increasing one's quality-of-life.^[28] For-profit healthcare introduces the idea of nonessential healthcare that can oftentimes more problems than solved.^[31] Likewise, performing excessive amounts of cosmetic surgeries can increase one's social standing, signifying that they have the means to afford expensive, luxurious surgeries that others cannot afford.^[31] For-profit healthcare promotes non-essential healthcare services so that more profits can be created from healthy populations.^[28]

The phrase "no margin, no mission" is often used to describe for-profit healthcare, where medical centers will adapt to corporate interests so they can stay in business.^[28][2] For physicians, this can mean not treating uninsured patients, performing unnecessary procedures that generate profit, or supplying better care to patients that have better means of pay.^[1] This also has great moral and ethical considerations for physicians who feel obligated to better care for well-insured patients as opposed to under-insured, vulnerable patients.^[32]

Corporate entities also enact standards over compliance, rules, disclosures and regulations.^[28] These rules disregard ethical and moral dilemmas that physicians often face, setting unattainable standards on situations that cannot be determined by a clause.^[20] Not only this, insurance companies also enforce rules and regulations surrounding medical treatment and payout.^[28] Physicians are often tied between healthcare corporations and insurance companies determining what they can and cannot do for a patient, whether it is necessary or not.^[33]

Manufacturers of medical devices fund medical education programs and physicians and hospitals directly to adopt the use of their devices.^[7] Many pharmaceutical and medical device companies are investor-based, meaning that if a device or drug receives FDA approval the physicians will be financially invested in its success or demise.^[22][5] Thus, a physician who is financially involved in a product or service is more likely to promote or use the product, whether or not its efficacy is known.^[2] This provides a complex conflict of interest for physicians and patients, who may not receive effective, safe treatment due to physician bias for one product over another.^[5]

According to Paul Starr, author of The Social Transformation of American Medicine, physicians hold a unique position between patients and hospitals.^[34] The MI Complex can increase efficiency in hospitals, where patients can enter and receive care at quicker rates.^[35][34]

Physician practices took a huge hit during the 2020 pandemic with thousands of primary care practices being forced to cut staff members due to the drop in patient volumes. These trends were consistent across the United States and other countries, detailing the difficulties the Medical Industrial Complex pertains with preparation for a pandemic like COVID-19. This was further detailed at the height of the COVID-19 pandemic, when one in every ten healthcare workers lost their jobs.^[36]

Laws and policies

The influence of economic policy on the practice of medicine has a long history.^[20]

The Dalkon Shield was an IUD introduced in the late 1970's and 1980's.^[37] The long-term effects of using this device were not well known, and the device ended up being very ineffective and dangerous, leading women to becoming pregnant or having severe complications.^[38] The manufacturers of this device said that their IUS was safer than other forms of birth control available, and none of their reports noted potential safety issues.^[37] When the device was discontinued after CDC and FDA investigations, the IUDs were not recalled and still produced dangerous complications for women who had them.^[37] This shows the dangerous background of the MI Complex and prioritizing profit over the safety and wellbeing of patients. Likewise, because this device did not prevent pregnancy, many fetuses with severe birth defects were born.^[38] The long-term effects of this device were not properly investigated and contributed to dangerous medical devices in the healthcare market.^[38][37]

The Safe Medical Devices Act of 1990 was passed by the FDA as an amendment to the FDCA and requires the manufacturer to report information about medical devices contributing to death, sickness, or injury.^[11] This allows healthcare professionals to report malfunctioning, unsafe medical equipment.^[10]

Certain drugs only offer expensive name-brand options and give patients no option to afford a cheaper, generic-brand medication.

The Physician Payments Sunshine Act from the United States Department of Justice declared that all consulting contracts and gifts medical device companies make with physicians must be made public.^[40] This curbs surgeons from promoting and overusing medical devices in patients based on bias.^[40]

In other countries

The healthcare system in the United States performs worse on health indicators compared to other major nations, despite the country's higher investment in healthcare.^[41] This is reflected in lower ratings for life expectancy and satisfaction among U.S. citizens, especially since the lack of universal health coverage is different in the United States than in other countries.^[42][43] Some major differences between the United States and other major counties include quality, access, efficiency, equity, and life expectancy.^[43]

White Savior Industrial Complex (WSIC)

Less developed countries do not always have the proper medical equipment to operate their practices. Due to this problem, the

The MI Complex is also present in India, where the Indian Medical Association lobbies for their interests at the local and state-level in politics.^[46] Specifically, some doctors have accused the Indian Medical Associations of engaging in unethical practices and obstructing the advancement of healthcare systems within the medical profession. The association has responded that they are just overemphasizing rare occasions of unethical practices. Yet, some doctors have privately admitted to immoral actions and have said that these practices are not limited to a few individual patients.^[45] Ethics is a hot topic of discussion not only within but also outside of the profession. These unethical practices could possibly be due to the large divide between healthcare systems in its different areas: tall, high-tech hospitals to dilapidated, dirty hospitals.^[47] So, there is a dilemma. Implementing stricter guidelines in the offices may be the solution to decreasing unethical practices, but it would increase the cost of healthcare for patients.^[45]

Because the General Agreement on Trade in Services regulates international marketplaces, in countries where the industrial-medical complex is strong there can be legal limitations to consumer options for accessing diverse healthcare services.^[48]

Brazil

In Brazil, the medical-industrial complex morphs into a "healthcare-industrial concept."^[49] The concept expands beyond Brazil, where medical demands are not met with internal infrastructure and patients cannot receive the products and services they need.^[49][50] Brazil's medical history arguably had poor distribution of social and economic medical policies, leaving the healthcare sector underdeveloped and underfunded in poor communities.^[51] The Program for Investment in the Health Industrial Complex, or PROCIS, funds medical research in Brazil to help move Brazil onto a global scale in pharmaceutical and medical industries.^[52][51] According to the Brazilian Ministry of Health, PROCIS was formed with the goal to develop Brazil's internal healthcare structure and promote research, development, and treatment.^[12] Over 100 billion Brazilian reals have been devoted to supporting medical research efforts, development of the medical industry, and innovating existing medical products.^[53] The PROCIS also established a margin of preference on healthcare products that were nationally funded and sourced.^[54]

See also

• List of industrial complexes
• Conflict of interest
• Continuing medical education
• Conflict of interest in the healthcare industry
• For-profit hospital
• Poverty and health in the United States
• Healthcare in Brazil

References