The medical-industrial complex

The medical-industrial complex Back in the 1950s, Eisenhower warned about what he called the military industrial complex, whereby a powerful coalition of generals and chief executives conspired to talk up the threat from the Soviet Union, exaggerating the so-called ‘missile gap’ and seeing threats where none existed.26 The goal was not to protect the United States, but instead to transfer vast sums of money from the federal budget to the coffers of the corporations, and ultimately to those generals who would move seamlessly into their employment on retirement. This is a model that has since been widely emulated. There is the security industrial complex, whereby corporations and government officials, many also looking for a lucrative retirement home, have conspired to spend billions of euros and dollars on ineffective systems of airport security.27 This has resulted in countless people having their cosmetics, nail files and the like confiscated while the few people who actually had bombs sailed straight through, even when they have done everything possible to draw attention to themselves.28 But it is now the medical industrial complex that is setting the rules of the game, by redefining the goals of health care away from those in most need, such as those with tropical diseases or ageing populations with chronic disorders and towards those who are essentially well. If the general practitioner is unwilling to respond to these pressures and incentives, many others will. In particular, those who do respond are the many private providers who offer so-called screening services using ever more complex imaging technology to visualise every part of one’s body to find entirely harmless anomalies for which they can extract money for giving what they call ‘treatment’. McCartney catalogues many examples, such as the treatment of surrogate markers, such as cholesterol, even at levels far below where it might do any harm, the creation of new so-called diseases, such as pre-diabetes, and treatment of raised levels of prostate-specific antigen, even at the cost of often appalling side effects while giving no overall benefit.17 Yet at the same time as people are being encouraged to spend ever greater sums of money on interventions that are useless, corporations are telling everyone that the rise in health care expenditure is unaffordable and must be rationed. Moreover, those same corporations are funding lobby groups, often in a manner that is far from transparent, to persuade governments and the public that the European welfare state is unsustainable, using highly selective and frequently misleading evidence. In some cases, where governments view the economic crisis as a once in a lifetime opportunity to roll back the welfare state, they are pushing at an open door.29 Conclusions European citizens today are like those who looked around them in Eastern Europe in 1989 and realised that the systems they inhabited were being run not for them but for a small elite. These systems were becoming increasingly dysfunctional and were failing to deliver on what they had promised. They had to change and they did. Today, it is equally clear that our systems have to change, but so far they have not. One of the first things that new public health trainees are taught is the importance of looking upstream, to the fundamental determinants of health. To make a difference to population health it is necessary to tackle the causes of the causes.30 The policies of austerity being pursued in Europe today are already impacting adversely on health, with rising suicides and denial of necessary care.6 Yet, as is now increasingly clear, they are not even doing what they were designed to achieve in the economy, instead they are choking recovery. As this paper has shown, many of those who promoted the deregulation of financial markets are now turning to the social sector as the next big opportunity to turn a profit. Yet their actions will not help those who need care and will medicalise the problems, real and imagined, of those who do not need it. Inevitably, scarce resources that could be used to alleviate genuine suffering will be wasted.