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What is corruption?

When I still lived in the US and Sani Abacha was the suddenly the dead ex-president of Nigeria, and it was therefore discovered he had looted billions from the Nigerian treasury, some of my friends in the US were aghast at the scale of his corruption. Apparently they did not read much international news, or much news at all perhaps.

My comment was “At least their leaders get a decent price”,  being of the view that to sell your constituent’s interests out to lobbyists in exchange for providing you the means to retain your position, as what, at the next election so you can repeat the process lacks ambition, any understanding of pricing, as well as integrity. That seems to me to be an accurate description of the relationship between lobbyists and the politicians they fund in America.

As I say, at least Mr. Abacha got a decent price for his integrity.

Which perhaps partially explains this map. One of world corruption based on the research and perspectives of those who prepared it. As the title asks, what is corruption?, so must have the map makers. How corruption is defined and measured, which varies with time and place of course, and who does the measuring. These fundamental things have an enormous impact on the results in such an exercise.

I think they missed most of the endemic corruption woven into western economies, of the type above and below. Corruption, after a great deal of practice in the developed world, has been refined to either a state of invisibility through familiarity. Or one of a pantomime everyone uses to pretend to themselves that this is just the way things are, or for a minority, to ensure they remain so.

But in any case it is legal when practiced on any scale worth studying, or mapping, in the light yellow or orange countries on that map. But if it is legal then it does not appear on this map. A kind of Catch-22, or of corruption all of itself really.

When thinking of really big examples the Bush sponsored Medicare Prescription Drug Improvement Act still comes to my mind first.

An Act that on the one hand makes prescription drugs cheaper and more available to seniors enrolled in Medicare. Old lady’s arthritis pills, what is not to like there? Within a contorted system of plans and rules it should be noted.

An Act that also expressly forbids the United States Government, the largest buyer of prescription drugs in the US, from negotiating lower drug prices from drug companies. Take a moment, let that sink in. Within a very simple system it should be noted.

This seems, to me, like it might be an example of corruption.

But not according to this map.

Senator Hillary Rodham Clinton (Democrat, New York) announced that she is working on legislation to improve the Medicare drug benefit by creating a regulatory structure to find and remove less-efficient private drug plans.  She also said that the government should have the authority to negotiate for lower drug prices in Medicare (which is strongly opposed by the pharmaceutical companies) and that pharmacists should be reimbursed for filling prescriptions for Medicare beneficiaries who were unable to prove eligibility because of computer glitches; and the February 15 deadline for reimbursing states offering Medicaid coverage to address coverage gaps should be extended - Link to source

When the custom was to speak plainly I think this was referred to as price rigging. But as with IQ tests, or SAT scores, or law enforcement, test results tend to provide as comfortable outcome as possible for those designing or administering the rules or laws, and more so as time passes. Intelligence declining according to historic measures? Grades and scholastic aptitude measures in decline? Too many of your friends prevented from expressing their desires by unreasonable limits imposed by a different interest group?

Don’t cheat, don’t break the rules or laws, that is corrupt. Change them, that is democracy.

In the more specific example below, as shown in the accompanying screenshot from my unsubscribe form submission with WebMD Professional, you can see mention of this type of legal corruption that few seem to see because it is part of the fabric of life. In this case it was a piece of that fabric I had not seen before, so it was shocking.

After unsubscribing I was asked the reasons for my leaving, and other questions WebMD thought might provide useful answers.

The most interesting to me was: “Do you only participate in programs sponsored by pharmaceutical companies when an honorarium is offered”.

I did not know that it was common, and legal, practice to pay doctors to listen to drug companies make presentations, did you?

I suspect that this information is presented either alongside, or perhaps even as, research or continuing education requirement courses offering credit to doctors who have to submit evidence they are keeping abreast of academic advances in their field. After all what else but interest or compulsion would make you travel across the country and stay in a hotel with a bunch of doctors, and attend a conference and it’s presentations and discussions?

Honorarium, far more mellifluous a word than any accurate alternative. Some examples? Substitute “bribe” or “inducement” in place of “honorarium” and the question would be as accurate, and more honest.

Paying someone to attend, no mention is made as to whether honorariums on average defray, meet or exceed the expense of attending for instance. Or that they are only offered if the party paying expects to profit from the act in some way. That might be by gaining a reputation as a sponsor of worthy causes I suppose. But these are drug companies paying doctors after all, and drug companies are first for-profit, not for-health, enterprises. What do you think the odds are that this practice is so widespread that it is regulated?

How large are honorariums, how do they vary, is there any correlation between the size of the payment and the market potential of the drug in dollar terms, how large are they compared to the expense of attending in specific drug categories, and on average, etc., etc.

That would be an interesting little project.

how drug companies bribe doctors
Unsubscribe screen shot composite from WebMD “Professional”