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Corruption in the pharmaceutical sector

Every once in a while this editor comes across something really spectacular. It happened in June when I read a report from the NGO Transparency International, written by Dr. Jillian Kohler and her team at the University of Toronto. The full 54-page report may be downloaded from the organization’s website. Dr. Kohler, who leads the WHO Collaborating Centre for Governance, Transparency and Accountability in the Pharmaceutical Sector has been active in this realm for many years, and in many areas, the only numbers and estimates come from this group. We all have heard about drug counterfeiting and the selling of substandard batches but the number and scope of corrupt activities in the industry, and in government are nothing less than astounding. The report concludes that corruption in the pharmaceutical sector is not yet treated as a distinct issue by key institutions, and that there is a lack of funding for anti-corruption research and interventions, creating a lack of data necessary to understand the complexity of the issue. Corruption includes the embezzlement of public health budgets, kickbacks in the procurement process, and bribery of governmental regulatory personnel. They report that as much as 6%, the equivalent of over US$ 300 billion of annual global health expenditures, is lost to corruption and errors. There have been many proposed remedies, but the will to enforce regulations and the required budget to apprehend lawbreakers seem to be in short supply, nearly everywhere. The WHO reports that about 25% of medicines consumed in lowand middle-income countries are falsified or substandard. Then, there are no accurate estimates of the expense or trauma caused by drug company representatives promoting pharmaceutical products to clinicians for unproven uses. The sale of expired drugs is seen as common, as is the approval of inferior drugs by unpaid or underpaid regulators or governmental inspectors. Most countries do not have the funds to scrutinize all aspects of drug promotion and some do not bother as the industry is able to employ leading law firms to fight governmental accusations or at a minimum, to tie up the attempted prosecution for many years. The report speaks enthusiastically about the new technology enabling track and trace methods to follow each individual package or bottle of medicine until it is deleted from the system when it is sold to the ultimate consumer. Money seems to be the rate limiting step in governmental drug regulatory agencies being able to crack down on corruption. Some new technologies are very costly and well beyond the means of some smaller and less developed countries, and often government employees are paid in arrears or not at all for lengthy periods of time. In such cases, probably only a very small bribe is needed to obtain some corrupt behaviour of such an impoverished regulator. The report also suggests that in order to ensure that fines do discourage pharmaceutical and biotechnology companies, they must be high enough to make the corrupt activity unprofitable and that regulations for such crimes should seek disgorgement of all profits generated through the illegal activity. Fines affecting a firm’s bottom line, making their results less attractive to investors and potential lenders should be effective in making the executives think twice about such behaviours in the future. Similarly, there is an emphasis in the USA and elsewhere to punish with fines and prison stays the actual culprits and not just the company. These numbers for falsified and substandard products in the distribution channels, coupled with the sale of expired products or products with inaccurate expiration dates, products sold with false outcomes or indications promises, and inferior products selected for formularies and reimbursement due to crooked decision makers are totally and completely unacceptable. It is good that the Transparency International report has been published. Now we need dedicated bureaucrats to do their jobs to decrease and even hopefully eliminate corruption in the pharmaceutical sphere. You might ask: ‘What can I do?’ and the answer is that