User:Annamirly/Medical–industrial complex: Difference between revisions

Pharmaceutical companies are a leading influence in the expansion of the Medical-Industrial Complex.<ref name="Lexchin-200320032">{{cite journal |last1=Lexchin |first1=J. |date=29 May 2003 |title=Pharmaceutical industry sponsorship and research outcome and quality: systematic review |journal=BMJ |volume=326 |issue=7400 |pages=1167–1170 |doi=10.1136/bmj.326.7400.1167 |pmc=156458 |pmid=12775614}}</ref> Generic pharmaceutical drugs, which have the same chemical properties as branded, profitable drugs, are often sold for a fraction of the cost of their counterparts.<ref>{{cite journal |last1=McCormack |first1=James |last2=Chmelicek |first2=John T. |date=October 2014 |title=Generic versus brand name: the other drug war |journal=Canadian Family Physician |volume=60 |issue=10 |pages=911 |pmc=4196814 |pmid=25316744}}</ref> For example, a 10 mg dose of asthma medication [[Singulair]] can cost up to $250 per month, whereas its [[Generic drug|generic]] counterpart [[Montelukast]] costs only ~$20 per month.<ref>"UpToDate". ''www.uptodate.com''. Retrieved 2022-10-17.{{full citation needed|date=November 2022}}</ref>

Despite the [[Inflation|inflated]] prices of brand-name drugs, pharmaceutical companies often induce [[bias]] in health care professionals by disproportionately promoting brand-name drugs.<ref name="WohlWohl2">Wohl, Stanley. ''The Medical Industrial Complex / Stanley Wohl.'' First edition. New York: Harmony Book, 1984: 85–98</ref> For example, research has shown that pharmaceutical companies promote branded drugs more, making physicians more likely to prescribe an expensive medicine over a generic alternative.<ref name="JupiterBurke2013">{{cite journal |last1=Jupiter |first1=Jesse |last2=Burke |first2=Dennis |year=2013 |title=Scott's parabola and the rise of the medical–industrial complex |journal=HAND |volume=8 |issue=3 |pages=249–252 |doi=10.1007/s11552-013-9526-5 |issn=1558-9447 |pmc=3745238 |pmid=24426930}}</ref>

Chain hospitals, in collaboration with [[Pharmaceutical industry|pharmaceutical companies]], lead to the escalation of [[Health economics|health costs]].<ref name="Wohl3Wohl2">Wohl, Stanley. ''The Medical Industrial Complex / Stanley Wohl.'' First edition. New York: Harmony Book, 1984: 85–98</ref> A chain hospital is a subsidiary of a [[hospital network]] that works under a for-profit goal of expanding healthcare and establishing hospitals across a country, most notably the United States.<ref name="Wohl-22">"Wohl's Bitter Medicine". ''Washington Post''. [[ISSN (identifier)|ISSN]] 0190-8286. Retrieved 2022-10-17.</ref> These corporations set standards regarding care administration, regulation, and enforcement– often without implementing a proper code of [[medical ethics]].<ref name="Levy-201222012">{{cite journal |last1=Levy |first1=Robert M. |date=March 2012 |title=The Extinction of Comprehensive Pain Management: A Casualty of the Medical-Industrial Complex or an Outdated Concept? |journal=Neuromodulation: Technology at the Neural Interface |volume=15 |issue=2 |pages=89–91 |doi=10.1111/j.1525-1403.2012.00444.x |pmid=22487596 |s2cid=30492373}}</ref> Chain hospitals and other healthcare conglomerates hold a monopoly over health care costs within their hospitals and respective [[Subsidiary|subsidiaries]].<ref>{{cite journal |last1=Lábaj |first1=Martin |last2=Silanič |first2=Peter |last3=Weiss |first3=Christoph |last4=Yontcheva |first4=Biliana |date=November 2018 |title=Market structure and competition in the healthcare industry: Results from a transition economy |url=https://research.wu.ac.at/files/19832866/10.1007_s10198-018-0959-1.pdf |journal=The European Journal of Health Economics |volume=19 |issue=8 |pages=1087–1110 |doi=10.1007/s10198-018-0959-1 |pmid=29445942 |doi-access=free}}</ref> Thus, they can [[Inflation|inflate]] healthcare costs with the goal to increase [[Profit (economics)|profit]], or lower [[Standard of care|hospital standards]] to cut corners where necessary.<ref name="Wohl3Wohl2" />

This cost inflation is exacerbated by the fact that [[Health care organization|health care organizations]] are increasingly managed by business staff rather, who often focus on economic gain, than local medical practitioners, whose focus is patient benefit.<ref name="Maloney-1998">{{cite journal |last1=Maloney |first1=FP |date=1998 |title=The emerging medical/industrial complex. The industrialization of medicine. |journal=Physician Executive |volume=24 |issue=2 |pages=34–8 |pmid=10180498}}</ref> Moreover, hospitals in one state can be monitored by systems elsewhere, which give significantly less power to local [[Health professional|healthcare professionals]].<ref name="JupiterBurke20132JupiterBurke2013">{{cite journal |last1=Jupiter |first1=Jesse |last2=Burke |first2=Dennis |year=2013 |title=Scott's parabola and the rise of the medical–industrial complex |journal=HAND |volume=8 |issue=3 |pages=249–252 |doi=10.1007/s11552-013-9526-5 |issn=1558-9447 |pmc=3745238 |pmid=24426930}}</ref> Reduced agency in turn decreases the personal relationships physicians can form with patients.

The curriculum of medical students often incorporates readings from large [[medical journal]]<nowiki/>s, like the [[The New England Journal of Medicine|New England Journal of Medicine]].<ref name="Levitsky-20072">{{cite journal |last1=Levitsky |first1=Sidney |date=February 2007 |title=Navigating the New 'Flat World' of Cardiothoracic Surgery |journal=The Annals of Thoracic Surgery |volume=83 |issue=2 |pages=361–369 |doi=10.1016/j.athoracsur.2006.10.100 |pmid=17257949}}</ref> These peer-reviewed journals may present results that favor expensive drugs manufactured by healthcare corporations or pharmaceutical companies, as these same corporations help to fund the journal.<ref name="Schofferman2011">{{cite journal |last1=Schofferman |first1=Jerome |year=2011 |title=The Medical-Industrial Complex, Professional Medical Associations, and Continuing Medical Education |journal=Pain Medicine |volume=12 |issue=12 |pages=1713–1719 |doi=10.1111/j.1526-4637.2011.01282.x |pmid=22145759 |doi-access=free}}</ref> As such, these large journals can perpetuate bias in healthcare providers' medication preferences through results that are inherently influenced by the motives of businesses.<ref name="Wohl5Wohl2">Wohl, Stanley. ''The Medical Industrial Complex / Stanley Wohl.'' First edition. New York: Harmony Book, 1984: 85–98</ref>

Beyond medical school education, [[continuing medical education]] for healthcare provides is also subject to biased curriculum that disproportionately promotes the interest of its funders.<ref name="Schofferman2011" /> To continue practicing as a [[Board certification|board-certified physician]], a physician must take continuing medical education courses. Such programs ensure that physicians are up-to-date with new medicines and treatment plans.<ref>{{Cite web |date=2017-03-20 |title=What is CME Credit? |url=https://www.nih.gov/about-nih/what-cme-credit |access-date=2022-10-22 |website=National Institutes of Health (NIH) |language=EN}}</ref> However, these continuing education courses are often sponsored by pharmaceutical companies and healthcare corporations that can instill [[bias]] in physicians' education via the material provided.<ref name="Pattison-19834">{{cite journal |last1=Pattison |first1=Robert V. |last2=Katz |first2=Hallie M. |date=11 August 1983 |title=Investor-Owned and Not-for-Profit Hospitals: A Comparison Based on California Data |journal=New England Journal of Medicine |volume=309 |issue=6 |pages=347–353 |doi=10.1056/NEJM198308113090606 |pmid=6346098}}</ref> For example, if a course is sponsored by a [[Medical device|medical device company]], then the coursework and exams used often reference using the company's medical device.<ref name="Wohl5Wohl2" /> In turn, when the course is completed, it is more likely that physicians will use that medical device when interacting with patients regardless of if that medical device is necessary in the patients treatment.<ref name="Wohl5Wohl2" /><ref name="Schofferman2011" />

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.<ref>{{Cite journal |last=Geyman |first=John |date=April 2021 |title=COVID-19 Has Revealed America's Broken Health Care System: What Can We Learn? |journal=International Journal of Health Services |language=en |volume=51 |issue=2 |pages=188–194 |doi=10.1177/0020731420985640 |issn=0020-7314 |pmid=33435794 |s2cid=231596061 |doi-access=free}}</ref>

A [[health professional]] offers a unique service to patients, since patients often defer to the guidance and wisdom of their healthcare provider.<ref name="Grouse-2014">{{cite journal |last1=Grouse |first1=Lawrence |date=September 2014 |title=Cost-effective medicine vs. the medical-industrial complex |journal=Journal of Thoracic Disease |volume=6 |issue=9 |pages=E203–E206 |doi=10.3978/j.issn.2072-1439.2014.09.01 |pmc=4178073 |pmid=25276402}}</ref> Many healthcare corporations are cognizant of the general populous's lack of medical knowledge and possess the ability to set prices. This is especially important as it involves the complex interaction between making a profit from a patient's suffering, but also physicians having to treat the patient as effectively as possible.<ref name="Relman-2009">{{cite journal |last1=Relman |first1=Arnold S. |date=24 September 2009 |title=Doctors as the Key to Health Care Reform |journal=New England Journal of Medicine |volume=361 |issue=13 |pages=1225–1227 |doi=10.1056/NEJMp0907925 |pmid=19776404}}</ref> For patients who do not have access to reliable [[health insurance]], this imposes expensive [[medical treatment]] that they must pay for.<ref name="Wohl2" />

For patients with a [[Chronic condition|chronic illness]], diagnosis often means expensive medications for the rest of one's life. Chronic illnesses like [[Depression (mood)|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.<ref name="Lexchin-20032" /> 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.<ref name="Wohl2" />

Physicians are subjected to the Medical-Industrial Complex and its manifestations. Throughout the 21st century''',''' [[plastic surgery]] has become more common, where people have surgeries performed to resolve a [[Cosmetics|cosmetic]] issue.<ref name="Wohl2" /> Cosmetic surgeries are often used to satisfy a certain [[Physical attractiveness|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|quality-of-life]].<ref name="Grouse-2014" /> [[For-profit hospital|For-profit healthcare]] introduces the idea of nonessential healthcare. For-profit healthcare promotes non-essential healthcare services so that more profits can be created from healthy populations.<ref name="Arab-2019">{{cite journal |last1=Arab |first1=Khalid |last2=Barasain |first2=Omar |last3=Altaweel |first3=Abdullah |last4=Alkhayyal |first4=Jawaher |last5=Alshiha |first5=Lulwah |last6=Barasain |first6=Rana |last7=Alessa |first7=Rania |last8=Alshaalan |first8=Hayfaa |date=August 2019 |title=Influence of Social Media on the Decision to Undergo a Cosmetic Procedure |journal=Plastic and Reconstructive Surgery – Global Open |volume=7 |issue=8 |pages=e2333 |doi=10.1097/GOX.0000000000002333 |pmc=6756652 |pmid=31592374}}</ref>

The phrase "no margin, no mission" is often used to describe for-profit healthcare, where [[Medical centers in the United States|medical centers]] will adapt to [[Corporatocracy|corporate interests]].<ref name="Grouse-2014" /> 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.<ref name="Wohl2" /> This also has great moral and ethical considerations for physicians who feel obligated to better care for well-[[Insurance|insured patients]] as opposed to under-insured, vulnerable patients.<ref>{{cite journal |last1=Christensen |first1=Richard C. |date=2005 |title=No Margin, No Mission: Health Care Organizations and the Quest for Ethical Excellence (review) |journal=Journal of Health Care for the Poor and Underserved |volume=16 |issue=1 |pages=168–170 |doi=10.1353/hpu.2005.0006 |s2cid=72636747}}</ref>

Corporate entities also enact standards over compliance, rules, disclosures and regulations.<ref name="Grouse-2014" /> These rules disregard [[Medical ethics|ethical]] and [[Morality|moral]] dilemmas that physicians often face, setting unattainable standards on situations that cannot be determined by a [[clause]].<ref name="JupiterBurke2013" /> Not only this, insurance companies also enforce rules and regulations surrounding medical treatment and payout.<ref name="Grouse-2014" /> 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.<ref>{{cite journal |last1=Poduval |first1=Murali |last2=Poduval |first2=Jayita |date=2008 |title=Medicine as a Corporate Enterprise: A Welcome Step? |journal=Mens Sana Monographs |volume=6 |issue=1 |pages=157–174 |doi=10.4103/0973-1229.34714 |doi-broken-date=2024-02-01 |pmc=3190548 |pmid=22013357 |doi-access=free}}</ref>

Manufacturers of [[Medical device|medical devices]] fund medical education programs''',''' physicians''',''' and hospitals directly to adopt the use of their devices.<ref name="BaggishNezhat1992" /> Many pharmaceutical and [[Medical device|medical device companies]] are investor-based, meaning that if a device or drug receives [[Food and Drug Administration|FDA]] approval''',''' investing physicians will be financially invested in its success or demise.<ref name="Maloney-1998" /><ref name="Xu-2022" /> 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.<ref name="Levy-2012" /> This provides a complex [[conflict of interest]] for [[Conflict of interest in the healthcare industry|physicians]] and patients, who may not receive effective, safe treatment due to physician bias for one product over another.<ref name="Xu-2022" />