Is there an insidious “iron triangle” in American health care?

Recent stories of government scientists from the National Institutes of Health (NIH) winning prizes for patents for drugs for COVID-19 highlight the dangerous “iron triangle” between Big Pharma, Big Health Care and government research and policy-making agencies. The Iron Triangles arise from the strengthening of financial and political ties between public services, private organizations and recipients of state aid. Once introduced on the ground, they can create a huge lever on public policy, self-finance their own political power (lobbying, campaign contributions) and generate huge growth and cash flow – and they are almost impossible to close. They are found throughout the public sector, from national defense to public welfare to healthcare.

The payment of royalties to NIH scientists involved in the development of drugs (and their patents) sold by private companies creates a kind of potential conflict of interest, especially when the leaders of these agencies pursue public policies for the use of these drugs. COVID certainly comes to mind because $ 50 billion in federal funds have been made available for research and development and the production and distribution of vaccines, leaving pharmaceutical companies with $ 100 billion in revenue and $ 40 billion in profits. The mRNA technologies and patents used to develop vaccines against COVID have led to a flow of government scientists’ fees for these and other drug breaches.

There have been intense legal battles over patents and the distribution of royalties between private companies and NIH scholars. This is not new; this happened with the drug for HIV AZT and other big, very profitable breakthroughs. Both Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and former NIH director Francis Collins have received such rewards, an Associated Press investigation found in 2005. Doctors said they donated to charity, but no one seems to know how much was paid, to whom and where the money went.

Extensive health care – hospitals, doctors, health care systems – benefits greatly from the administration of vaccinations and other drugs and depends on Fauci’s annual budget allocation of nearly $ 5 billion in external research money, so no one is likely to raise obvious questions about correctness, nor about the pressure of Fauci / NIH to use vaccines. Most recipient universities and other private medical research centers, of course, celebrate Fauci’s leadership. All questions about NIH or Fauci decisions are called “misinformation” and, as we saw with COVID, “not following science.” But “following the money” continues to raise some important issues.

NIH’s secrecy is reflected in the next leg of the triangle, Big Pharma, which has grown dramatically and could account for up to 15 percent of all health care spending. It is projected to be the fastest growing segment of healthcare spending in the future. Studies over the past 20 years have shown that Big Pharma has contributed about 9% of the operating budget of leading medical schools such as Stanford and the University of Pennsylvania, nearly 30% of continuing medical education costs for doctors and made large payments to leading deans. medical faculties. Medical associations and schools say this has been limited, but as with the NIH, there is little or no evidence available to investigate. The iron triangle appears to be wearing an invisible cloak.

Unfortunately, all of this may partly explain why medical education is increasingly reduced to vertical specialized silos, following algorithms that teach students to “name it”, “use it or cut it (and then use it”), and “Charge”. Four-year-old medical students have to memorize a huge range of medications and drug applications, literally doubling their vocabulary. And, of course, Medicare & Medicaid Services (CMS) and insurance companies pay according to these diagnostic / treatment / billing frameworks, further supporting modern, robotic, drug-based medical treatment.

Is it any wonder that politicians, NIH scientists and university research and medical schools would like to be closely associated with this money machine? And, of course, both Republicans and Democrats are on board.

Then the question arises: Does this give Americans a longer and healthier life? Apparently No.

During the COVID pandemic, there was evidence that many Americans with poor metabolic health and overweight were at very high risk of serious illness and death. Similarly, Americans with poor metabolic health and high levels of inflammation are at greatest risk for nine of the 10 most deadly diseases. Life expectancy in the United States has been declining for years before Covid, despite rising health care costs. Excessive sugar intake is the main culprit. Still, the NIH inexplicably joined the U.S. Department of Agriculture (USDA) in 2021 to approve high sugar content standards for American and government-funded foods. If you think of sugar as a dangerous addictive drug, you could say that the NIH / USDA supports Big Pharma and Big Farma. You could also say that NIH is becoming a misnomer. These are the National Institutes of Medicine and Treatment – there is the money.

A possible example is the growing number of Americans who become addicted to antidepressants – which can have many side effects and do not seem to “cure” anything, e.g. the last 20 years. Another example: A study published in 2017 in JAMA Cardiology found that statin use increased by 80 percent in one decade (221 million prescriptions per year) and yet preventable heart disease is a killer № 1 for men and women. taking almost twice as many lives a year as COVID did. The best heart surgeons in the country cite these deaths as preventable with an optimal diet and lifestyle – but where is the pressure from the NIH on this?

The bottom line is that health care spending is skyrocketing, but Americans are no healthier. Americans are getting sicker, taking more drugs, and living shorter lives. We Americans love superheroes who save the day and prevent widespread death and disaster. Now may be the time for a new breed of superheroes to invade and break the Iron Health Triangle.

Gradi means is a writer and former corporate strategy consultant. He has served in the White House as a political aide to Vice President Nelson Rockefeller and a full-time economist with the U.S. Department of Health, Education and Welfare. He linked the White House to the National Health Insurance Experiment, chaired the Food Voucher Reform Working Group, and helped draft and implement the HMO Act of 1973. Follow him on and on Twitter @ gradymeans1.

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