User:Annamirly/Medical–industrial complex

In 1961, President Dwight D. Eisenhower commented on the influence and immensity of the military in American society in his farewell address, “...we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex.”^[20] This new term, the military-industrial complex, depicts a sphere of influence between a national military and the defense industry which provides essential supplies to the military. Deriving from this, the term “industrial complex” is used to describe the conflict of interest between an institution's supposed goal, and the desire to profit from the businesses/agencies that profit from serving the institution. The medical-industrial complex sits alongside the military-industrial complex and the prison-industrial complex, among others, to delineate the influence of free market capitalism in sociopolitical systems/institutions.

In “The Medical Industrial Complex,” the emergence of the American medical industrial complex is attributed to “the growing rapport between the delivery and products industry.”^[21] This definition of the medical-industrial complex describes the history of the American healthcare system, specifically the creation of social programs Medicare and Medicaid, as an industry that has transformed into a central, essential role of the American national economy. References to the perpetuation of healthcare disparities by the medical-industrial complex are described, such as “class and cultural antagonisms” and the differences in accessibility between rural and urban populations, are made at this time.^[21]

In 1980, Dr. Arnold S. Relman published a further discussion of the medical-industrial complex in The New England Journal of Medicine when he was editor-in-chief, entitled “The New Medical-Industrial Complex.”^[22] Relman notably explicitly excludes pharmaceutical companies and medical equipment companies in his description of the medical-industrial complex. Relman argues that “in a capitalistic society there are no practical alternatives to the private manufacture of drugs and medical equipment.”^[22] Relman still identifies the novelty of the modern medical-industrial complex, describing the medical-industrial complex as an “unprecedented phenomenon with broad and potentially troubling implications.”^[22] As with the Ehrenreich definition, the medical-industrial complex continues an emphasis on profit maximization on behalf of private corporations. The “cream-skimming” phenomenon is described here, where proprietary hospitals can “skim the cream” off the market, by focusing on wealthy patients who can afford the most profitable procedures and services; nonprofit hospitals are therefore left with the remaining patient base.^[23]

In the 21st century, the medical industrial complex has come to encompass a system of oppression and subject of critical analysis by scholars. The Health Justice Commons describes the medical-industrial complex as intertwined institutions, including big pharma, as well as health insurance companies, medical technology companies, and governmental regulatory bodies.^[24] Per the Health Justice Commons, the medical-industrial complex reinforces “racism, sexism, classism, homophobia, transphobia and ableism."^[24] The nature and extent of the medical-industrial complex is a subject of debate by scholars, including those who specialize in fields of critical theory, such as disability studies, queer theory, and Black studies. One such scholar is Mia Mingus, who has attempted to visualize the medical industrial complex graphically.^[25]

Image Description: “There are four main quadrants, each in a different color with large matching colored arrows connecting the outer broad categories to inner underlying motives: “Science and Medicine” is connected to “Eugenics;” “Access” to “Charity and Ableism;” “Health” to “Desirability;” and “Safety” to “Population Control.”

Mia Mingus' diagram of the medical industrial complex (MIC) diagram suggests that: (1) at the root of our societal conception of health is desirability, (2) at the root of safety is population control, (3) at the root of access is charity and ableism, and (4) at the root of science and medicine is eugenics. Mingus shows the connection between health and desirability by providing examples of forced healing and cosmetic medical procedures that alter individuals within the health industry. She connects safety to population control by highlighting the prison industrial complex. Mingus does not elaborate on this connection, although other sources have noted that mass incarceration is often viewed as  the latest in a series of institutions created to enforce the racial hierarchy in the United States,"^[26] given the significantly higher percentage of black individuals in prisons or jails (37%) as compared to the relative percentage of Black individuals in the population (13%)^[27]. Mingus roots access in charity and ableism by describing institutions such as non-profits and insurance companies. She states that “non-profits were included directly next to Charity and Eugenics because of the ways that they have helped to frame how we understand things such as “cure” and “rescue,” and dutifully fundraised millions of dollars in the process.^[28]” Similarly, according to encyclopedia.com, the Medical-Industrial Complex has “certainly contributed to improvements in the health status of the population,” but “it has also strengthened and preserved the private sector and protected a plurality of vested interests.”^[29] Finally, Mingus’ diagram roots science and medicine in eugenic practices, providing bio-colonialism as evidence for this connection. This relationship between science and eugenics is expanded on in the Francis Galton History Section below.

The existence of the medical-industrial complex as a concept is a product of the development of the modern American healthcare system. In the 19th century, the profession and practice of medicine was drastically developed. Experimentation on enslaved people was common. Doctors such as gynecologist J. Marion Sims operated on enslaved black women without anesthesia in order to document and develop gynecological medical issues and techniques to repair them.^[30] The creation of hospitals to treat the sick create further disparities in favor of urban, white populations.^[31]

The modern American healthcare system occurred following World War II, with the passage of the Hill-Burton Act, Medicare, Medicaid, and most recently, the Affordable Care Act. The latter social programs attempt to diminish the disparity of populations with difficulties maintaining health insurance, but does not attempt to reduce the private sector. The medical-industrial complex endeavors to reconcile the modern healthcare establishment with the long term health inequalities.

Many authors discuss the MIC in a negative light, focusing on how the MIC perpetuates the oppression and disablement of marginalized groups of people. Such authors include Rana A. Hogarth, Eli Clare, and Francis Galton.

Francis Galton was a statistician who helped to developed the idea of eugenics in 1904. Galton defined eugenics as “the science which deals with all influences that improve and develop the inborn qualities of a race” with the goal of “represent[ing] each class or sect by its best specimens, causing them to contribute more than their proportion to the next generation.”^[32] Galton’s concept of eugenics soon propagated ideas that certain groups of people, whether they were distinguished by race, ability, or socioeconomic status, were superior to others. Renowned journals, such as Nature, published work by Galton and other eugenicists, thereby making it easier for eugenics to become a legitimate field in science.^[32]

In turn, eugenics practices have played a prominent role in the history of the MIC. Some of these instances of eugenics are infamous in society, such as the justification of the mass ethnic genocide of Jewish people during the Holocaust by arguing that society was in need of racial purification.^[33] Other examples of eugenics, such as the selective abortion of children with disabilities, are more controversial.

Other notable eugenic-like practices include compulsory sterilization of black and poor individuals and scientific racism.

Rana A. Hogarth, in her novel “Medicalizing Blackness,” discusses the “the ways in which blackness was reified in medical discourses and used to perpetuate notions of white supremacy,” and, consequently, harm and oppression. For example, Hogarth discusses how “white physicians constructed images of healthy and robust black bodies capable of enduring brutal labor regimes” while also identifying “deficiencies within these bodies that disqualified them for self-government.” Importantly, Hogarth argues that oppression of black individuals using science predates the justification of slavery, and, instead has more to do with the origins of the medical industrial complex that allowed for the “intellectual, professional, and pecuniary gains” of physicians in the English-speaking greater Caribbean region over those of black individuals.^[34]

Eli Clare describes the Medical-Industrial Complex from a negative view, stating that, through the MIC “All of our body-­ minds are judged in one way or another, found to be normal or abnormal, valuable or disposable, healthy or unhealthy” He argues that the MIC is a critical component of the ideology of cure by shaping “our understandings of health and well-­ being, disability and disease” and perpetuating the idea that bodies and minds need improving. Clare describes the MIC as being pervasive throughout our lived experiences, “sustained by the labor of many people, ranging from doctors to nursing home administrators, nursing aides to psychiatrists, physical therapists to researchers, scientists to marketing directors.” Moreover, he states that it is perpetuated by pharmaceutical companies, medical ad agencies, laboratories and all health facilities. Simultaneously, Clare acknowledges that cure, and thus the medical industrial complex, has helped many individuals to cope with chronic diseases or illnesses that have caused them pain.^[35]

Pharmaceutical companies and chain hospitals are key healthcare corporations within the Medical Industrial complex.

Healthcare corporations are connected with the creation of chain hospitals.^[36] 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.^[37] These corporations set standards regarding care administration, regulation, and enforcement without fully acknowledging medical ethics and their manifestations.^[38] Chain hospitals combined with conglomerate pharmaceutical companies lead to an increase in the price a patient will pay for a single hospital visit.^[36] This increase can be felt throughout their visit and lifelong medications can also have lasting influence.^[39]

Pharmaceutical companies are a leading influence in the expansion of the Medical-Industrial Complex.^[40] 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.^[41] For example, a 10 mg dose of asthma medication Singulair can cost up to $250 per month, whereas its generic counterpart Montelukast costs only ~$20 per month.^[42] The inflated prices of brand-name drugs contributes to a worsening health climate where certain patients can barely afford their monthly medications. This creates long-term cycles of poverty and lack of resources for patients and those who depend upon them.^[43]

Despite the inflated prices of brand-name drugs, pharmaceutical companies often induce bias in health care professionals by disproportionately promoting brand-name drugs.^[43] For example, research has shown that pharmaceutical companies promote branded drugs more, 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. 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 making physicians more likely to prescribe an expensive medicine over a generic alternative.^[44] if they are familiar with the drug brand.

In addition to drugs, Laboratory Tests are also influenced by pharmaceutical company's vested interests. Physicians are more likely to order unnecessary tests when they are advertised by familiar pharmaceutical companies.^[45] Like branded drugs, many pharmaceutical companies set these tests at inflated prices in an effort to increase profit.^[45]

Chain hospitals, in collaboration with pharmaceutical companies, lead to the escalation of health costs.^[46] 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.^[37] These corporations set standards regarding care administration, regulation, and enforcement– often without implementing a proper code of medical ethics.^[38] Chain hospitals and other healthcare conglomerates hold a monopoly over health care costs within their hospitals and respective subsidiaries.^[47] Thus, they can inflate healthcare costs with the goal to increase profit, or lower hospital standards to cut corners where necessary.^[46]

This cost inflation is exacerbated by the fact that the management of 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 is one of the trends of the increasing influence of the medical-industrial complex.^[48] Moreover, hospitals in one state can be monitored by systems elsewhere, which give significantly less power to local healthcare professionals.^[49] Reduced agency in turn decreases the personal relationships physicians can form with patients. Physicians who know their local government and people can feel less obligated to support the members of their community.^[49] Likewise, it decreases the personal relationships physicians can form with patients.^[49] Standards set by chain hospitals also set compliance rules, disclosures, and regulations that are oftentimes unattainable by healthcare professionals.^[49] Overall, chain hospitals are structured with a goal of profit in mind that often disregard the physicians and healthcare professionals that play a front-line role in treatment, prevention, and detection.^[46] Chain hospitals are often associated with for-profit hospitals.^[46][50]

Environmental responsibility

The U.S. national health expenditure as percent of GDP in 2021 was 18.3 Percent, up from 13.3 in 2000.

The Medical-Industrial Complex MIC 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. 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.

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.

A health professional offers a unique service to patients, since patients often defer are oftentimes completely vulnerable to the guidance and wisdom of their healthcare provider. Likewise, a patient needs unique, reliable help, especially in situations where they are physically, emotionally, and oftentimes financially vulnerable. Many healthcare corporations are cognizant of the general populous's lack of medical knowledge exploit this vulnerability and possess the ability to set prices can often in-debt patients as a result. For example, if a person is involved in a car accident and becomes unable to communicate, they are taken to the nearest hospital. Thus, they cannot refuse nor accept medical treatment. 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. For patients who do not have access to reliable health insurance, this imposes expensive medical treatment that they must pay for.

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. 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.

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 (CITATION). This led to racial disparities in COVID-19 deaths for African Americans (CITATION). For example, In 2020, African Americans infected with COVID-19 died at a rate of 97.9 out of every 100,000, which is a death rate over double compared to white people (46.6/100,000) and Asians (40.4/100,000), and a third higher than Latinos (64.7/100,000); however, the death rate of African Americans is comparable to Indigenous populations (81.9/100,000).^[51]

Physicians are subjective 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 cosmetic issue. 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. For-profit healthcare introduces the idea of nonessential healthcare. that can oftentimes more problems than solved. 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. For-profit healthcare promotes non-essential healthcare services so that more profits can be created from healthy populations.

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. 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. 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.

Corporate entities also enact standards over compliance, rules, disclosures and regulations. These rules disregard ethical and moral dilemmas that physicians often face, setting unattainable standards on situations that cannot be determined by a clause. Not only this, insurance companies also enforce rules and regulations surrounding medical treatment and payout. 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.

Manufacturers of medical devices fund medical education programs, and physicians, and hospitals directly to adopt the use of their devices. Many pharmaceutical and medical device companies are investor-based, meaning that if a device or drug receives FDA approval, the investing physicians will be financially invested in its success or demise. 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. 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.

According to Paul Starr, author of The Social Transformation of American Medicine, physicians hold a unique position between patients and hospitals(CITATION??). The MI Complex MIC can increase efficiency in hospitals, where patients can enter and receive care at quicker rates.

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 MIC 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.

As indicated in Mia Mingus' diagram above, the "Medical Industrial Complex" is intertwined with the effects of economic policy on the practice of medicine. The Dalkon Shield is an interesting example of the conflict between economic profit and patient well being:

The Dalkon Shield was an IUD introduced in the late 1970's and 1980's. However, the long-term effects of the Dalkon Shield were not well known, and this IUD ended up being both ineffective and dangerous, resulting in women becoming pregnant and facing severe pregnancy complications. The manufacturers of the device claimed that their IUD was safer than other forms of birth control available, and none of their reports noted any safety issues. However, the long-term effects of the Dalkon Shield were not well known, and the IUD ended up being both ineffective and dangerous, resulting in many women becoming pregnant and facing severe pregnancy complications. Moreover, because the device promised pregnancy prevention, many fetuses with severe birth defects were born as mothers did not follow the medically-advised precautions during their pregnancy. When the device was discontinued after CDC and FDA investigations, the IUDs was still not recalled and continued to endanger women who had them. 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. As such, the Dalkon Shield remained a dangerous medical device available in the healthcare market.

Over a decade since the invention of the Dalkon Shield, the Safe Medical Devices Act of 1990 was passed by the FDA as an amendment to the FDCA. This act required medical device manufacturer to report any information about medical devices that could contribute to death, sickness, or injury. As such, healthcare professionals were required to report malfunctioning or unsafe medical equipment.

Certain drugs only offer expensive name-brand options and give patients no option to afford a cheaper, generic-brand medication. This monopoly was brought to the United States Supreme Court and was ruled constitutional if corporations pay to maintain their monopolies.

Additionally, the Physician Payments Sunshine Act, created by the United States Department of Justice, declared that all contracts that medical device companies make with physicians must be made public. As such, this act could prevent future physicians from promoting or overusing medical devices on patients to further personal interests over patient benefit.

 

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.^[52] This is reflected in lower ratings for life expectancy and satisfaction among U.S. citizens, partly because the United States does not provide universal health coverage, unlike other nations especially since the lack of universal health coverage is different in the United States than in other countries.^[53][54] Some major differences between the United States and other major countries counties include quality, access, efficiency, equity, and life expectancy.^[54]

White Savior Industrial Complex (WSIC)

Countries in the Global South do not always have the same amount and quality of resources as countries in the Global NorthLess developed countries do not always have the proper medical equipment to operate their practices.^[55] Due to these disparities this problem, scholars argue that the White Savior Industrial Complex has permeated surfaced in countries in the Global South, such as like India and Uganda. Coined by Teju Cole, the White Savior Industrial Complex refers to the phenomenon where privileged white individuals seek personal fulfillment by trying to "liberate, rescue, or otherwise uplift underprivileged people of color"a dominant group's influence over another group.^[55][56] According to this concept, people with a white savior mentality may believe think they know what's best but often end up perpetuating in reality actually does more harm than good. Some scholars claim that white savior practices of white saviorism can be traced drawn back to White Westerners traveling and settling in different places around the world.^[57] A personal anecdote describes recalls how a white American physician caused influenced and made Ugandan medical staff to doubt their knowledge and ability in delivering a baby doubt themselves on how to deliver a baby.^[55] Another personal anecdote recounts notes how a White male physician male that used his privilege to influence medical staff in India to subvert their traditional medical practices to switch their social norms of gender.^[55] He treated a woman, who initially refused to be treated by a male foreigner. Scholars cite these Instances like the two anecdotes as are just a few examples of how widespread the White Savior Industrial Complex WSIC has become is becoming.^[55]

India

Some individuals claim that the medical-industrial complex MI Complex also exists is also present in India, where the Indian Medical Association lobbies for their interests in local and state politics at the local and state-level in politics.^[58] 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.^[57] The Indian Medical Association has responded to these claims by stating that their critics they are just exaggerate overemphasizing rare occasions of unethical practices.^[57] Yet, some doctors have privately admitted to immoral actions and have stated said that these practices are not limited to a few individual patients.^[57] Ethics is a contentious topic hot topic of discussion, both within and beyond the medical not only within but also outside of the profession. These Claims of unethical practices may stem from could possibly be due to the stark contrast the large divide between healthcare systems ranging from in its different areas: tall, high-tech hospitals to dilapidated, dirty ones hospitals.^[59] So, there is a dilemma. Some medical professionals and scholars suggest that implementing stricter office guidelines guidelines in the offices may decrease be the solution to decreasing unethical practices, but this could also raise it would increase the cost of healthcare for patients.^[57]

Some scholars argue that due to Because the role of the General Agreement on Trade in Services in regulating regulates international marketplaces, in countries with strong medical-industrial complexes where the industrial-medical complex is strong may impose there can be legal limitations on consumer access to to consumer options for accessing diverse healthcare services.^[60]

In Brazil, scholars refer to the medical-industrial complex as the morphs into a "healthcare-industrial complex concept."^[61] The healthcare-industrial complex concept also expands beyond Brazil, where internal infrastructure fails to meet medical demands, leaving patients unable to access necessary products and services where medical demands are not met with internal infrastructure and patients cannot receive the products and services they need.^[61][62] Scholars argue that Brazil's medical history reflects arguably had poor distribution of social and economic medical policies, resulting in underdeveloped and underfunded healthcare sectors leaving the healthcare sector underdeveloped and underfunded in poor communities.^[63] The Program for Investment in the Health Industrial Complex, or PROCIS, funds medical research in Brazil to advance the country's global presence help move Brazil onto a global scale in pharmaceutical and medical industries.^[64][63] 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.^[65] Over 100 billion Brazilian reals have been devoted to supporting medical research efforts, development of the medical industry, and innovating existing medical products.^[66] The PROCIS also established a margin of preference on healthcare products that were nationally funded and sourced.^[67]

Alternative approaches to the medical-industrial complex incorporate elements from different theoretical frameworks and practices, such as holism, alternative medicine, environmentalism, reproductive justice, the disability rights movement, feminism, and other related concepts.^[13][14] These alternative approaches stem from the collective efforts of historically marginalized activists facing structural violence, including Indigenous, Black, and migrant communities.^[15] According to various scholars, these alternative approaches aim to reimagine health as a holistic concept that extends beyond the traditional focus of the medical-industrial complex to include the body, mind, and spirit.^[13][14][16] Furthermore, these alternative approaches challenge the medicalization of illness and disease by highlighting how structural factors shape health rather than individual behaviors.^{[15][16][17][18]} Alternative approaches to the medical-industrial complex also challenge the boundaries between patient and provider to encourage collaboration and center the lived experiences of individuals in the healing process.^{[13][14][16][18]} Additionally, they highlight the importance of forming caring relationships within one’s community to establish a sense of solidarity among individuals as equal participants in the healing process.^[13] One specific alternative approach is mindfulness, which emphasizes how the resources and tools for healing exist within the self and not within the solutions offered by the medical-industrial complex.^[16] Another distinct approach from the medical-industrial complex is alternative health, which incorporates elements of traditional medicine and focuses on addressing underlying factors of disease rather than merely treating symptoms.^[14] Alternative health, as a new social movement, provides a space for individuals and communities with diverse lived experiences to actively participate in the healthcare system while emphasizing their humanity in the healing process.^[19]

• 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
• Medicalization
• Mia Mingus
• Eli Clare
• Compulsory sterilization
• Scientific racism
• Eugenics
• Healthcare in the United States