The Palliative Machine: Medical Monopoly Under the Corporation-State

The Palliative Machine: Medical Monopoly Under the Corporation-State

The American medical system is corrupt, ineffective and unnecessarily costly. These outcomes are due to state violence on behalf of the politically connected elite (namely private insurers, physicians, pharmaceutical and medical device companies). Artificial scarcity, price-gouging, misallocation of research funding and the suppression of alternative (non-patentable) therapies can be ameliorated by revoking state-conferred elite privilege and re-establishing cooperative, mutualized healthcare financing.

"Was the government to prescribe to us our medicine and diet, our bodies would be in such keeping as our souls are now."

Thomas Jefferson, Notes on the State of Virginia, Query 17, 157–61

Grocery Insurance

The essential problem with medical financing is described by the Grocery Insurance analogy— third party payment (nominally "private" insurers or the state) divorces price from cost, distributes responsibility, suppresses competition and puts upward pressure on prices: when your insurer only requires a small deductible for each trip to the supermarket, you will probably buy a lot more caviar, filet mignon and white truffle oil.

Likewise, the seller will raise prices. When someone else pays, the seller and the buyer do not have antagonistic interests; the seller wants to charge higher prices and the buyer does not care. Ultimately, costs are externalized. Insurance companies are unscrupulous in their efforts to contain costs, deny coverage and swindle customers (as a matter of necessity) – despite it all, costs are aggregated within the insurance fund and redistributed in the form of higher premiums for everyone. There is no such thing as a free lunch, and the insurance model is based on trying to eat yours.

The state, as disorganized as it is, has less incentive to ruthlessly minimize costs, but immense waste is written off as necessary humanitarian spending. The state suffers diseconomies of scale, bureaucratic inertia, lacks incentive to economize and by its nature the state is centralized and prone to corruption. Hospitals, drug companies and doctors take advantage of the inept Panopticon by price gouging, pushing drugs and executing unnecessary procedures.

Thus, the two-pronged system of unaccountability drives healthcare costs in one direction – up. Meanwhile, tax and premium-payers are gouged with nowhere to turn – to the point at which 17% of U.S. GDP and 23% of the Federal budget is spent on sick care. Nobody should blame sick people for the broken system; they operate within very narrow constraints, especially lack of access to healthy food, clean water, accurate medical information and they endure unsafe working conditions. Claiming that people are hedonistic free-riders is facile. Few will make healthy choices because of the specter of future medical costs; they do so to avoid contracting a disease. The problem is that there are few choices, period, and they're all unhealthy.

Let Food be Thy Medicine, or Hippocrates Rolling In His Grave

American culture is not conducive to optimal health. Quintessential American foods are hot dogs, hamburgers, soda and culturally appropriated "ethnic food" with enhanced salt, fat and sugar content. The state has made it hard for individuals (especially the poor) to consume healthy food.

Centrally mandated 5-year plans called Farm Bills subsidize certain foods (corn, soy, wheat, canola, sugar, dairy), allow for genetic modification, petrochemical biocides and fertilizers and disempower local producers. The state claims to be protecting family farmers, which hardly exist anymore. These protections actually subsidize the profits of companies like Monsanto, Syngenta, ConAgra and Archer Daniels Midland (ADM). Indeed, to manipulate prices, some farmers are paid not to produce food.

This is the economic insanity of Chomsky's socialized-cost, privatized-profit agriculture; the Soviet Union failed for similar reasons, particularly the Hayekian knowledge problem. Blend the impossibility of calculating the appropriate parameters of a complex system with institutionalized corporate corruption and viola - the American agricultural system. As ADM's own Dwayne Andreas trenchantly quipped: "There isn't one grain of anything in the world that is sold in a free market. Not one! The only place you see a free market is in the speeches of politicians." [1] Quite, Mr. Andreas, and you are the beneficiary.

The food crisis is characterized by overabundance of unhealthy foods and scarcity of healthy ones. In the inner city, "food deserts" have arisen; large radii wherein markets with fresh produce cannot be found – just liquor stores and gun shops. Radically rational solutions include large-scale urban agricultural projects like Growing Power, the Transition Movement and Cleveland's cooperative Evergreen City Growers. The food crisis is not the focus of this inquiry, but is critical nonetheless.

The water quality is not so great either. Fluoride, chlorine, heavy metals, agricultural runoff and synthetic compounds including pharmaceuticals, DDT and bisphenol-A contaminate the water that the state is ostensibly responsible for safeguarding. More and more communities are removing the forced-medication of fluoride from the water, but this is easy relative to, say, preventing coal-sourced mercury residues from building up in the watershed. Water filtration is a vitally important mechanism that unfortunately selects against the poor or uninformed.

The long-term sustainable solution to the healthcare crisis is to get to the root of illness – diet and lifestyle. Then questions about costs and administrative technicalities would be moot. However, if society attained a high level of health, some people (perhaps those with predominantly genetic disorders) might still experience lackluster care. Unfortunately, within current constraints it is unlikely that enough people have the awareness and agency to fix their health if left to their own devices. Therefore, the medical system must be remade to stop hurting people (but not by force, property expropriation, or other forms of authoritarianism).

The Temple of The M.D.

"First, Do No Harm." – Hippocrates

The white coats are seen as the god-kings of science (and physicians often believe it, developing arrogant god-complexes themselves). Their achieved status typically results from ascribed status; only those born into affluent families can afford to become physicians in the first place. This perpetuates a classist-notion of intellectual superiority and paternalistic "I Know Best" healthcare decision-making.

The relationship of the doctor (the Latin root being docere, or to teach) and the patient is no longer one of compassion, respect and free contract; there is a power asymmetry where the doctor cannot be questioned (and he ridicules unorthodox ideas).They even have special uniforms, titles and prestige salaries to bolster their superiority. Doctors start to believe they know everything and they are reflexively dismissive of treatments they were not taught about in school.

It was not so long ago that Dr. Ignaz Semmelweis was driven out of practice (and mad) by daring to suggest that physicians wash their hands between doing autopsies and delivering babies. He was later known as the "Hungarian Savior of Women," because new mothers' infection rates dropped precipitously after his crackpot theory was put into practice.

All that being said, doctors can also be lifesavers, saints, geniuses and visionaries. But the present medical system does not attract these types, nor is it conducive to bringing out these qualities in practitioners. The problem does not lie with the individual, but with the institution. Most police officers are not repressive thugs themselves, but the institution of policing serves to quell dissent, wage war on poor people and protect the stolen property of the elite. As Omali Yeshitela said, a militarized police force "only becomes necessary at that juncture of society where there are those that have and those that have not."

A Destructive Trade Union: The American Medical Association

Conservatives have long held private labor unions in contempt. They claim that consumers are hurt by higher prices, unions use terrorist tactics, and Rand's "persecuted minority" of big businessmen and corporate shareholders are slighted by the haughty demands of uppity workers.

Leaving aside the fact that labor unions established the eight-hour day, weekends and eliminated child labor, labor unions are vital to economic models of liberal capitalism; organized labor is the engine behind rising wages. The claims that labor unions are unjust are hard to take seriously, given the importance of the Labor Movement in the early 20th century in securing basic conditions of decency in the workplace. [2] In any case, worker's cooperatives render both unions and bosses obsolete and are indeed more efficient than capitalist enterprises founded on the slave-master relationship. [3]

But there is at least one pseudo-union that is unquestionably destructive: The American Medical Association. The AMA uses its considerable political leverage to limit the number of doctors that can be trained annually, making doctors artificially scarce and fetching higher salaries on the market. First declared in 1924 by Morris Fishbein, the AMA continues to wage a covert war against competing modalities like chiropractic, naturopathy and midwifery. The same crusade is fought by the American Dental Association, American Cancer Society, National Cancer Institute and American Academy of Pediatrics. [4]

One must pay for an MD, D.O., N.D. degree and a government license to practice even basic medicine. Medical schools and physicians are artificially scarce and state-mandated pharmacies only recognize their legitimacy to write prescriptions. Patients must pay for the amortized cost of medical school to get a simple prescription for antibiotics. In China, physicians called barefoot doctors receive a moderate amount of medical training and travel the country treating common medical conditions like infection and fractures. [5] In tandem with the aging baby boomers requiring more medical care, there is a desperate shortage of medical providers. Like the guild they are, the AMA is lobbying to prevent nurse practitioners and physician's assistants from practicing without the paternalistic oversight of a white coat. [6]

Only doctors may take serious medical risks and make serious medical mistakes. Just how major are the blunders that doctors may make is a vexed question, and it is hard to see how it could ever be completely otherwise. At what point does reasonable risk become negligence? When does the necessarily chancy business of fending off the angel of death become a license to commit horrendous cock-ups?

At present, the British rule is that 'doctors' who have been certified by the government (that is, by the government sponsored medical oligarchy – this point can't be made too often for it is the essence of the matter) may take much more severe medical risks than may those who are only 'doctors' in the opinion of their patients.

If a (government certified) doctor carries out a medical operation of some sort and it goes wrong (as operations inevitably will from time to time), well, these things happen. You can't be a doctor and not commit the medical equivalent of mistiming the occasional cover drive, fumbling your lines or committing the occasional typographical error. On the other hand, if you aren't a 'doctor' and you take medical risks, then even if all goes well, you are in legal trouble. [7]

In effect, a licensure monopoly protects negligence that has been deemed reasonable by the state and bars certain types of people from practicing medicine despite demand from patients.

The Coup D'état – Flexner Report

Pharmaceutical drugs have not always been the primary treatment option in the West. Prior to 1910, the dominant forms of medicine were nutritional, herbal, osteopathic, and surgical. Pill popping and "A Pill For Every Ill" are relatively novel phenomena.

The shift toward petro-chemical derived pharmaceutical treatment began in 1910, with John D. Rockefeller and Andrew Carnegie's educational coup d'état, the Flexner Report. The report was a piece of research reformatted into a formal proposal, accompanied by massive donations to certain colleges (bribes), which established the code of the medical institutions we have today. The primary stipulation was that these schools would emphasize pharmaceutical drugs over traditional methods of treatment.

The report also recommended the merger of medical schools with universities, which drove up the cost of medical education, limiting access to all but upper class white males. Also, the pact mandated that new medical schools could not be established without state approval. The robber barons restructured the medical education system because they wanted to remodel their public image, but also to fabricate a profit-generating industry in the decades to come. [8] Rockefeller was also a eugenicist, hoping to craft an Übermensch using the new field of genetics, which he largely financed at Columbia and the Cold Spring Harbor Laboratory.

It is doubtful that even the robber barons could fathom how out-of-hand the drug situation has become. The same lack of foresight probably applies to Rockefeller's Standard Oil monopoly—in his gasoline evangelism, John D. probably didn't expect geopolitics to revolve around petroleum as it does today. Unknown but influential policy changes can have lasting, chaotic effects. This is especially true when simple legislation that, by the stroke of a pen, has the power to unleash the potent propaganda known as direct-to-consumer advertising.

Thirty years ago Merck's aggressive chief executive Henry Gadsden told Fortune magazine of his distress that the company's potential markets had been limited to sick people. Suggesting he'd rather Merck to be 'more like chewing gum maker Wrigley's,' Gadsden lamented it had long been his dream to make drugs for healthy people. Because then, Merck would be able to 'sell to everyone.' Three decades on, the late Henry Gadsden's dream has come true. [9]

Direct-to-consumer advertising began in 1981, and really took off in 1995. Big pharma convinces you that you're sick, that you've "got bad genes," and only petrochemical-based pharmaceutical drugs will make you whole. To support this myth, companies like Pfizer, Ely Lilly, AstraZeneca, GlaxoSmithKline and Sandoz are often caught colluding with academia to misrepresent drug efficacy to doctors. The disease industry has also been lobbying politicians to ensure that profits are maximized on every front, regardless of the human consequences.

These days, big pharma pushes drugs for chronic depression and ADD. These are Band-Aid treatments—the first purportedly lifting mood and deadening emotion in order to numb patients to the ills of their environment, and the second dosing children with addictive amphetamines so they become over-stimulated robots that eventually develop psychoses and adrenal exhaustion. All this in an attempt to "normalize" behavior. Emotional response is elicited by environmental stimuli. In other words, there is a reason why children don't sit still in the Prussian military-modeled public school system, and justification for feeling chronically depressed in the modern world.

Pharmaceutical drug interactions cannot be predicted with any confidence. "The average person over 65 now uses seven different medications per day, four prescribed and three over-the- counter," said Andrew Duxbury, MD, associate professor of geriatrics at the University of Alabama at Birmingham and director of the senior care clinic at UAB's Kirklin Clinic. "There's never been a controlled study on a human being involving more than three drugs circulating in the body at the same time. So no one knows, scientifically, exactly what's going on in your body when you take seven, 10, or a dozen at a time." [10]

Doctors know a lot about pharmacology, but not much about nutrition or preventative medicine. Dietary and lifestyle factors are the leading cause of premature death. [11] Doctors receive an abysmal amount of dietetic education. A 2006 study of all the medical schools in the United States found that less than 41% of the 106 respondents provided the minimum 25 hours or more recommended by the National Academy of Sciences in 1985. [12] This recommendation was made while advertisements for "healthy" margarine were on air – with trans fats now known to increase cancer and heart disease incidence.

Needless to say, perhaps in 1985 we underestimated the importance of nutrition and in light of modern evidence, the recommendation should be more than a paltry 25-hour minimum. Twenty-five hours of schooling equals two hours a day, five days a week for two and a half weeks total. That's nothing, given how important diet and lifestyle factors are in pathogenesis. In the same study, 88% of instructors expressed the need for additional nutritional education.

Bad Science

It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine. – Marcia Angell, M.D.

How do drugs that prove dangerous get such a stalwart reputation in the medical community to begin with? Misrepresentation of data by Big Pharma, the FDA, and international regulatory agencies was a major factor. The FDA was once funded entirely by the federal government (a time when corporate co-optation was actually frowned upon).

In 1992, George H.W. Bush changed the rules, and the FDA now derives over 40% of revenue from fees charged to pharmaceutical companies. Britain's version of the FDA derives 70% of revenues from drug companies, thanks to Margaret Thatcher's earlier reforms in the 80s. The FDA having a monopoly on regulation is bad enough, and the aforementioned mercantilist conservatives simply required bold-faced bribery. The solution is to de-monopolize regulation and enable entities like the Environmental Working Group or Underwriters Laboratories to certify safety and quality.

Today, there is a revolving door of public policy, lobbying, academia and corporate influence. There are myriad methods employed to misrepresent the research. Not all of it is published—only about 40% of research finds its way to a journal. Of those that do, there is a "publication bias," where studies that find positive results (that the drugs work) are more often published than those that show the drugs don't work or are toxic.

Another technique is "Salami slicing"—Big Pharma will cite the same data multiple times in numerous studies. There is no profit motive for independently funded research that seeks to take dangerous drugs off the market. Further, independent research is not published in the major journals like The Lancet or NEJM. Finally, standard cooking of the books, or fun with numbers: anyone along the chain of command can, with a keystroke, corrupt the data. Industry-supported research must be taken with colossal, hypertension-inducing grains of salt. [13]

For example, a meta-analysis of 166 studies on Monsanto's artificial sweetener aspartame correlated funding source with findings. Seventy-four were funded by industry and 92 were independently funded. One hundred percent of industry-funded studies found the food additive safe, whereas 92% of the independently funded research identified a problem. [14]

Such hazards include neurological excitotoxicity, seizures, mood disorders, headaches, increased appetite and cancer. [15] [16] Of the six "independently" funded studies that found no dangers, five of them were conducted by the FDA. Again, that leaves one out of 92 independently funded study finding the substance safe. To this day, aspartame is the most complained-about substance to the FDA, which insists the sweetener is safe.

Intellectual "Property" – The Patent Monopoly

Property rights are limited to that which is finite, or of limited reproducibility. Ideas are not physically scarce. Likewise, oxygen is not scarce so it is impractical to consider it property. Land is scarce—they ain't making any more of it. There is a good reason to utilize property rights to organize non-violently. But what happens when supposed property does not physically exist? This is the case with intellectual property. It is an illegitimate, artificial form of property that only exists because of state violence. The byproducts of patent "rights" are monopoly rents to the owner and artificial scarcity for everyone else. This topic is treated in detail elsewhere. [17] [18]

Some believe patents are a necessary evil to entice people to develop new ideas and technologies. First, it's unclear whether most intellectuals are primarily motivated by windfall profits. Profit is never the inspiration for great minds. As Jonas Salk, the developer of the Polio vaccine, stated, "There is no patent. Could you patent the sun?" He had a higher intention for his discovery; he did not want anyone to suffer needlessly so that scientific pockets may be padded with cash.

But even assuming some socially valuable research would not occur without the potential for windfall profit, there is a naturally occurring market mechanism that rewards originality: price gouging. There is a period of time between which the invention is brought to market and when competitors are able to reverse-engineer and manufacture their own version. This window allows the originator to charge a high price (if they value their marginal personal gain over availability for poor people). Most importantly, though, eliminating patents would allow for more creativity. As it stands, developers can't build upon the ideas of others without paying royalties. This slows technological progress.

In the case of pharmaceutical drugs this dynamic is particularly pernicious. A recent study found pharma spent 24.4% of their sales dollar on promotion, versus 13.4% for research and development, as a percentage of US domestic sales of $235.4 billion. [19] The artificially high prices protected by patents deprive the poor of necessary goods, as is the case with malaria and AIDs medication throughout the developing world. Generic drugs, sold at cost of production, could ameliorate this tragedy. Today, people are dying to boost profits. By all measures, the pharmaceutical industry is the most profitable of all. [20]

The combined profits for the ten drug companies in the Fortune 500 ($35.9 billion) were more than the profits for all the other 490 businesses put together ($33.7 billion) [in 2002]. Over the past two decades the pharmaceutical industry has moved very far from its original high purpose of discovering and producing useful new drugs. Now primarily a marketing machine to sell drugs of dubious benefit, this industry uses its wealth and power to co-opt every institution that might stand in its way, including the US Congress, the FDA, academic medical centers, and the medical profession itself. – Marcia Angell, M.D.

Profits 500 Fortune
For more from former editor-in-chief of the NEJM, Marcia Angell, see The Truth About the Drug Companies,  Your Dangerous Drugstore, and Drug Companies and Doctors.

The Drug Merchants

Medicine makes you die slowly. – Plutarch

Researching the pharmaceutical industry crushes one's faith in humanity. It is like reading about King Leopold's Congo, or medical research within Nazi concentration camps. The sheer force of elite sociopathy is staggering. The laundry list of crime is too long to be retold here, but suffice to say, the entire industry has been accused of crimes against humanity at the International Criminal Court in the Hague. [21]

Xenobiotic drugs are chemical compounds not found in nature, and for which humans lack efficient detoxification pathways. They are also the only treatment that pharmaceutical companies can patent. Herbal or dietary treatments have not been embraced by the illness industry as they cannot be patented. This is precisely why the dietary methods of Hippocrates, Pythagoras, Galen, Avicenna and today's burgeoning legion of doctors of natural medicine are attacked and disparaged by the vampiric hegemony. Regardless, the public is waking up, and many doctors defect to alternative medicine and demand within that sector is growing rapidly. [22]

The Food and Drug Agency is the Gestapo arm of the medical-industrial complex, furthering the machine's blitzkrieg on true health and longevity. For decades, the FDA routinely carried out raids on food co-ops, medical doctors using alternative therapies, farms, even churches in an effort to suppress authentic therapies. They send in vans full of SWAT teams with M16 rifles, handcuffs and bulletproof vests. Documents, computers, money, herbs and devices are confiscated, and excessive damage is done to the facilities. The FDA justifies the raids based on charges that are later dropped, and they routinely levy exorbitant fines against their target after the fact. [23]

The thing that bugs me is that the people think the FDA is protecting them. It isn't. What the FDA is doing and what the public thinks its doing are as different as day and night. - Dr. Herbert Ley, former commissioner of the FDA (1968-9)

The FDA restricts timely and affordable access to necessary drugs, lies about safety and efficacy to protect profits, suppresses alternative therapies and discredits physicians who successfully utilize them. [24]

In 2010, President Barack Obama appointed former Monsanto lawyer Michael Taylor as Deputy Commissioner of Food at the FDA. Throughout his career, Taylor vacillated between representing Monsanto and working for the FDA — a revolving door par excellance. In 1994, Taylor mandated that FDA not require the labeling of recombinant bovine growth hormone (rBGH), [25] which is toxic to humans and cows. [26] It is banned in more civilized countries like Canada, Australia and Japan (and the entire European Union).

Until July 1988, U.S. customs officials confiscated any dextran sulfate that AIDS sufferers brought back from Japan. The drug showed some efficacy in inhibiting the HIV virus' ability to attack white blood cells. Shouldn't sick people be free to inform and treat themselves? The same logic applies to the failed, draconian War on Drugs; a sovereign individual is fully within their right to administer any substance to themselves, no matter the personal consequences. Only when they aggress against another has a person transgressed.

There are many unorthodox therapies for cancer, like Dr. Stanislaw Burzynski's antineoplastons, [27] the Gerson protocol, Essiac tea, ellagic acid, laetrile, high-dose ascorbic acid, electromagnetic therapy, and dozens of dietary therapies. [28] These are all highly controversial, mostly not because they're risky, but because if any one of them worked, it threatens patent-monopolized pharmaceutical company profits. In any case, the efficacy and toxicology of these therapies is irrelevant; individuals must be free to choose their medicine. As it stands, the FDA sues, fines, imprisons, and revokes the license of any physician that uses forbidden methods.

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Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of GreenMedInfo or its staff.

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Incredible analysis

Thank you for sharing this essay... It really touches all relevant issues leading to lack of health and the reasons behind this situation. Excellent work

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