Category Archives: corruption

Military research dilemmas

Should peace activists care about corruption and exploitation in military research?

military censorship

In May 2015, a new law will take effect in Australia concerning military-related research and development. The law has many critics, including leaders of Australian universities. Among the law’s opponents is Brendan Jones, a high-tech entrepreneur. In a strongly argued article in the December issue of  Australasian Science, he lays out the case against the new law. The article begins:

From 17 May 2015, when the Defence Trade Controls Act (DTCA) comes into effect, the federal Department of Defence will gain control over a very large share of high-tech and science research in Australia. Under the Act, publication, discussion or communication of research without a Defence permit will be punishable by up to 10 years jail, a $425,000 fine and forfeiture of research to the government. This includes scientists, academics, librarians, engineers, high-tech workers and companies that have never had a prior relationship with the Department of Defence.

Jones has been passionate in raising the alarm about the DTCA. He claims his business was the victim of depredations by the Australian Department of Defence, which took over his intellectual property without any compensation, causing his business to fail. If it had just been him, he might not have tried to expose it, but after he found out about several other similar cases, he decided he had to act.

It appears the Defence Department has its own favoured business partners. The department seeks out promising research and uses the ideas for its own purposes, without permission or compensation. The DTCA will legalise this sort of extractive process, backing it with punitive penalties for resistance.

Jones quotes several organisations and high-tech entrepreneurs who are critical of the DTCA. And not just critical — some of the entrepreneurs are planning to leave Australia. Jones is one of them, but not without a fight.

For months, Jones has been writing the most amazingly comprehensive treatments of the problems facing whistleblowers in Australia, typically in the form of open letters to politicians. It’s because of his interest in whistleblowing that I have been in touch with him. I’ve commented on drafts of several of his open letters, and posted a couple of them on my website.

whistleblower_460

Jones wrote a highly informative treatment of how whistleblowers should interact with journalists. In preparing his article, he contacted numerous journalists for feedback and advice. His article, “A whistleblower’s guide to journalists,” is the best available treatment on this topic. One of his recommendations for whistleblowers is to always remain anonymous if possible.

Several of Jones’ open letters are impressive pieces of research, with dozens or even hundreds of footnotes with references, quotes and examples. If you want a compendium of serious cases of corruption in Australia, Jones’ “Royal petition concerning federal government corruption” is the best available. Likewise, for a powerful indictment of the state of free speech in Australia, it is hard to go past his “Debunking Dreyfus on free speech and freedom.

Corruption in the military

Military expenditures are huge and highly subject to corruption. In many countries, the government runs a monopoly. In others, notably the US, the government buys from favoured suppliers. Because of secrecy and the pretext of national security, shonky operations prosper. In the US, where the processes are best documented, there is a revolving door for top-level military personnel, who join companies and lobby to obtain lucrative contracts.

One of the most famous early whistleblowers in the US was A. Ernest Fitzgerald, who in the 1980s exposed a $2 billion cost overrun in a military aircraft project. Taking inflation into account, this would be more like $20 billion in today’s dollars. For his efforts, Fitzgerald was subject to the usual methods of discrediting, harassment and sidelining. He wrote two books exposing corruption in US military contracting: The High Priests of Waste and The Pentagonists.

high-priests-of-waste

Over the years I’ve talked with quite a few military whistleblowers. They seldom have an easy time. Corruption is as common in the military as in any other part of society, perhaps more common; speaking out about it is quite a bit riskier, because reprisals can be severe, and sometimes whistleblowers are physically attacked. Few areas pose this level of danger to whistleblowers.

There’s a fascinating connection between military corruption and whistleblower laws. During the US civil war, President Abraham Lincoln was disgusted by companies cheating the government when providing military supplies, because their shoddy goods were undermining the war effort.

Lincoln-memorial

The government passed the False Claims Act, allowing whistleblowers who exposed companies defrauding the government to take legal action on behalf of the government, sometimes with the backing of the Department of Justice. The act provides financial rewards to these whistleblowers when prosecutions of corrupt companies are successful. The False Claims Act was revived in 1986 in response to corruption during a massive expansion in military expenditures, and is now widely seen as one of the most powerful pieces of whistleblower legislation. In Australia, the government has long resisted introduction of a similar law.

A dilemma for peace activists?

I’ve been involved with peace issues since the 1970s, and occasionally pondered the question of military corruption and waste. Should a peace activist care? Perhaps military waste is better than military efficiency!

In 1982, Mary Kaldor, a prominent figure in the European peace movement, authored a book entitled The Baroque Arsenal. She argued that military technology was becoming ever more gigantic in scale, high-cost and elaborate, rather like baroque churches that took decades to build. The result was that many weapons systems were becoming almost irrelevant for actual war-fighting: they were not rational from the point of view of military efficiency.

Baroque-arsenal

After I read Kaldor’s book, not long after it was published, I wrote in my notes about it, “But all this has little direct relevance to how to move against war. It seems more useful for those military and civilian planners who would like to truly modernise their armaments towards new industries and simplicity.”

Another thought: perhaps it is better for money to be wasted on inefficient, pointless technological monstrosities, especially if they don’t work. Billions of dollars spent on fighters or bombers that were never deployed might be better than less money spent on lean, efficient tools for killing.

On the other hand, when a military force has more than enough firepower for its purposes, additional expenditures may be pure waste and a drag on society. Furthermore, military corruption and waste may lead to lobbying for more funding: beneficiaries of boondoggles will seek to find ways to continue and increase their income streams. And even if some projects for new fighters or submarines are dropped after the expenditure of billions of dollars, this doesn’t mean other weapons disappear. Whatever the level of waste, rifles keep being produced.

Recently I read Paul Koistinen’s book State of War. His analysis of US military systems supports Kaldor’s analysis. Koistinen writes:

As a form of state capitalism, the defense sector was freed from practically all competitive market pressures. Under those circumstances, the industry became characterized by inefficiency, waste, and corruption; defense contractors too often turned out defective or failed weapons and equipment. Over time, massive expenditures for defense have had a very deleterious effect on the economy. These outlays have led to the hoarding of capital and human resources, especially among scientists and engineers, and to the diverting of public assistance from civilian enterprises. Of crucial significance, according to numerous critics, DOD [Department of Defense] budgets have distorted public priorities and spending, denying adequate attention and resources to infrastructure, education, medical care, and other public services and interests. (p. 235)

state-of-war

Activists have long stated that military spending would be more beneficial if redirected to human needs. However, making the military more efficient does not guarantee that savings will be redeployed for clean water, housing, education or health. Military efficiency might simply mean more money is available for weapons systems.

The DTCA brought back memories of these issues. The DTCA can be thought of as a straitjacket for Australian military-related research. Arguably, it will hinder research and development, with the additional side effect of undermining related civilian research, especially concerning so-called dual-use technologies, which can be adapted for military or civilian purposes.

Another possibility is that military systems that are fair and honest might be more open to switching to nonmilitary production. For decades, there has been a small but dedicated push for what is called “economic conversion” or “peace conversion,” which means switching from military production to production for civilian needs, for example from military vehicles to public transport. After the end of the cold war in 1989, there were great hopes that much such conversion would take place, as it did after the end of World Wars I and II. But these hopes were dashed: the military-industrial complex continued pretty much as before while searching for a new rationale. (Terrorism turned out to be the prime justification.)

peace-conversion-task-force-cartoon-sized-down-adapted-300x235

It does seem plausible that military research and development that is riddled with corrupt and exploitative practices will be resistant to change, because corrupt operators are less subject to rational argument and planning. On the other hand, corrupt systems are less likely to lead to efficient killing machines. Perhaps the world is a safer place if nuclear weapons contractors cut corners in manufacturing, design and maintenance, so that weapons, if ever used, miss their targets or simply won’t work. In this scenario, the baroque arsenal that Mary Kaldor warned about is not such a bad thing: incredibly wasteful but less deadly than it might otherwise be.

militarywastetitle2

An alternative research agenda

There is an alternative to military defence based on civilian methods of nonviolent action such as rallies, strikes, boycotts and occupations. Many people, because they believe violence always triumphs over nonviolence, see this as totally implausible, but there is good evidence that nonviolent methods can be more effective than armed struggle in challenging repressive regimes, because the goal is to win over the opponent, including the opponent’s troops.

The arguments about nonviolent defence – also called civilian-based defence, social defence and defence by civil resistance – have been canvassed elsewhere. Their relevance here is that if this alternative is taken seriously, it leads to an entirely different agenda for research, development and infrastructure. For example, decentralised renewable energy systems are much more suited for surviving an occupation, a blockade or a terrorist attack than centralised energy systems based on fossil fuels or nuclear power. Analogous considerations apply to communications, transport, agriculture and construction. A nonviolence-driven research agenda would give far more attention to social sciences and would change priorities in nearly every field of study.

From this point of view, the DTCA and problems of corruption in the military seem almost irrelevant. Research continues to be driven by military priorities, whether done efficiently or not.

Back to practicalities

A reorientation of military expenditures towards nonviolent alternatives is almost completely off the agenda. It proceeds only to the extent that developments, for example in energy and communications, increase the capacity of citizens to take action. As seen in the Arab spring and other nonviolent movements, network communication systems help citizens organise and coordinate actions.

For now, I will continue to support two seemingly disparate agendas: one is nonviolent defence and the other is dissent, including those who challenge the DTCA and other such legislation.

censored-igor-saktor
Image: Igor Saktor, The Australian

I’ve talked to a number of people in the military about nonviolent defence. Although most are sceptical about whether it could work, they recognise a common interest in thinking strategically about defending against aggression. Indeed, many officers would prefer to never have to fire a weapon in anger, seeing deterrence and prevention as superior to fighting.

In the same way, there can be a worthwhile dialogue and sharing of concerns when it comes to supporting integrity and free speech in the military. I will continue to support military whistleblowers and hope others will too.

Brian Martin
bmartin@uow.edu.au

I thank Anu Bissoonauth-Bedford, Jørgen Johansen, Brendan Jones, Anne Melano, Brian Rappert and Kim Sawyer for valuable comments on drafts.

Jørgen Johansen comments

There are several discussions running in parallel here: one about the waste in military spending, one on the corruption in the military-industrial complex, one on defending a country without violent means, and one on the morality of having an inefficient military system compared to an efficient one. Even if they are related I think these should be held separate. One reason is that addressing topics separately makes it easier to understand, analyse, and act.

More importantly, for anyone who wants to oppose military/violent/corrupt systems, it is strategically important to confront them one at a time. To lump them together makes it almost impossible to “sell the arguments” and/or build alliances with those who are engaged in only one of these topics.

Too many activists are trapped in a fundamentalist attitude; “If you don’t agree with us on veganism, feminism, pacifism, sustainable energy, bi- and trans-sexuality, … we cannot have you in our group.” Almost all successful movements have focused on more limited questions, such as universal voting rights, anti-slavery, civil rights (anti-segregation), anti-personnel mines and anti-whaling.

If you don’t plan to write a huge book, there is no way you can properly describe all the complexities of the issues you mention in a single blog. This is of course not an argument against your topic for the blog, but advice for those who want to take up any of the issues you present and to run a campaign.

A final thought: it should not be on the peace movement’s agenda to discuss what sort of military means we want to see. Leave that to others.

Whistleblowing and loyalty

Whistleblowers can gain insights from Jonathan Haidt’s studies of the foundations for morality.

Whistleblowers are people who speak out in the public interest, for example to expose corruption, abuse or dangers to the public. Surely this should be seen as a valuable service. Yet whistleblowers are frequently treated as traitors, as guilty of something worse than the abuses and crimes they reveal.

In-case-of-whistleblower-break-glass

National security whistleblowers, such as Chelsea Manning and Edward Snowden, have been called traitors. Whistleblowers who are teachers, police officers, public servants or corporate executives may be called traitors, dobbers, snitches or other epithets.

Just as important as words are the reprisals that whistleblowers experience, including ostracism, petty harassment, demotions, referral to psychiatrists and dismissal. To be targeted with such hostile actions signifies condemnation, even contempt. Where does this vitriol and hostility come from?

Also important is the role of bystanders, in particular the co-workers who might personally support the whistleblower but are unwilling to take a stand. Many of them are afraid they will become targets themselves; others always support management, sometimes in the hope of rewards. It is reasonable to ask, where does the incredible power of the organisation come from?

The Righteous Mind

Insights can be gained from Jonathan Haidt’s book The Righteous Mind. Haidt, a psychologist, set out to discover the biological bases of human morality. But first it is useful to explain Haidt’s picture of the mind.

Righteous_Mind

Imagine that your mind has two main components. The first is a rational, calculating operator that can examine courses of action and logically consider principles of behaviour. This is how most people think of themselves. Haidt calls this component the “rider.”

The second part of the mind is an intuitive operator that makes judgements on the basis of gut instinct, without consideration for facts or logic. This part is filled with passions and commitments, which the rider might consider biased and impulsive. Haidt calls this second part of the mind the “elephant.” The elephant makes day-to-day life possible; its quick responses are often sensible — but not always.

Haidt uses the metaphors of the rider and the elephant to highlight a key insight from studies of the mind: for many purposes, rational evaluation is unable to restrain instinctive responses. The elephant is too large and powerful to be controlled by the rider.

Haidt, through careful assessment of psychological research, concludes that in most cases the primary role of the rider is to figure out ways to justify what the elephant does. In other words, people reach their views about the world on the basis of gut instinct, and then their rational minds figure out reasons to justify these views.

Elephant and Rider

This is not a pretty picture, especially for those who believe in the primacy of rationality, or believe that they personally follow reason rather than emotion.

The next step in Haidt’s analysis is discovering the foundations of morality. Through a variety of means, he arrived at six main foundations that shape people’s senses of right and wrong: care, liberty, fairness, loyalty, authority and sanctity. Haidt used various tests to work out which of these values influence judgements in US people. He found that “liberals” (who might be called progressives in Australia) rely especially on care, liberty and fairness, whereas conservatives rely more equally on all of the foundations. This helps explain some of the political differences in the US.

Most of these foundations are relevant to whistleblowers. One key foundation, care, means looking after those in need, for example children and people suffering misfortune. When whistleblowers speak out about abuse of children or shortcomings in health services, they are implicitly appealing to the care foundation for morality. Another foundation, fairness, is relevant for those who speak out about corruption, including bribery, theft and nepotism. These are all violations of fairness.

So far so good. But whistleblowers come up against some of the other foundations. They are seen to be disloyal (to their employers), undermining authority (of their bosses) and sometimes transgressing on things considered sacred (such as when revealing confidential information). Haidt’s framework suggests that whistleblowers can gain support from some foundations of morality but are up against instinctive responses based on others.

At this point it is worth remembering the rider-elephant metaphor. Few people sit around scrutinising the bases of their own morality. Rather, their ideas of right and wrong are intuitive: they react with their gut and then search for rational justifications for their feelings. So if someone’s morality is strongly shaped by respect for authority, they may react emotionally against a co-worker who breaks ranks and then find reasons for their antagonism.

Sometimes there are multiple sources of authority. For example, a person can accept the authority of church leaders or seek a higher authority in the teachings of spiritual leaders such as Buddha, Jesus or Mohammed. However, the rider-elephant factor enters in here: because most teachings can be interpreted in various ways, the rider can find ways of justifying the elephant’s actions. For example, even when religious texts oppose killing, most religious leaders allow participation in war, using various rationalisations.

However, it seems too simple to say that whistleblowers put a priority on care, fairness and liberty (moral priorities for liberals) whereas bosses put a priority on loyalty and authority (which influence conservatives more than liberals). Whistleblowers vary greatly in their beliefs; many are the epitome of the loyal employee. Furthermore, what about all the bystanders, who by their inaction support bosses and let whistleblowers cop it? They are bound to include people driven by a variety of moral precepts.

loyal_employee

Various researchers have tried to figure out what, psychologically, makes whistleblowers different from others. Employers would love to know, so they could avoid hiring potential whistleblowers or, having hired one, keep them away from sensitive information. Given the lack of any reliable psychological tests to detect potential whistleblowers, it is safe to assume that psychology is not the key to understanding whistleblowing. This is especially the case for inadvertent whistleblowers, the workers who report a problem, are totally surprised when they experience reprisals, and afterwards say “I was just doing my job.” There are psychological factors involved in this, for example honesty and conscientiousness, but no obvious connection to the foundations of morality traced by Haidt. Or is there?

Care versus loyalty?

Sexual abuse is a violation of the morality of care: those who are vulnerable need to be protected. Speaking out about the abuse, on the other hand, challenges authority and loyalty.

Consider, for example, sexual abuse by clergy. The disturbing reality is that many people in churches knew about it but took little or no action. This can be interpreted as loyalty and authority taking precedence over care. On the other hand, the response of many members of the public, when they learned about the abuse, was completely different: many were horrified and disgusted. As outsiders, their conceptions of loyalty were potentially quite different. They may have had no particular connection to the church, or perhaps had their own loyalty, for example to their children.

But what about authority? Those who are not directly subject to a particular authority may not think deference to it is so important. This observation is compatible with the advice that whistleblowers can gain greatest support from other whistleblowers and from members of the public, for example through media stories.

So morality based on authority seems, at least when it applies to whistleblowers, to be quite specific: deference to authority takes precedence mainly when people are directly subject to the authority, as in the case of bosses or church leaders. This deference can also be explained a different way: people are afraid of the consequences of bucking authority. They might lose their job or, just as worrying, be subject to reprisals such as reprimands, harassment and ostracism. It might seem that fear is a fundamental factor in this dimension of morality.

Loyalty to what?

For me, this raises another question. Why should the two factors of loyalty and authority be tied to the organisation where a person works? In terms of evolution, humans lived in groups whose very survival often depended on banding together. Dissent was potentially dangerous, so it could have been advantageous to attack or expel those who challenged the group’s leaders or threatened its cohesion.

However, many groups today are a far cry from the groups in human prehistory, which were often quite small and probably never much more than a few hundred people in size. Working for a government or corporation with thousands of employees is not the same, neither in scale nor in the danger to the organisation of a bit of dissent.

This suggests to me that although loyalty is a key factor in morality, how loyalty is assigned remains open. Inside a school, for example, a pupil might be loyal to a peer group, a sporting team, a teacher or the school as a whole. In a corporation, a worker might be loyal to a work team, a union, professional peers in the field, a particular boss or the company as a whole. The possibility that loyalty is not automatic suggests that it is worth looking at the methods by which organisations foster it.

Changing gut reactions to whistleblowers

It’s worth considering each of Haidt’s six foundations for morality and asking, what can be done, by whistleblowers and their supporters, to change gut reactions to whistleblowing so it is more valued? The foundations of care, fairness and liberty are ones that should create favourable attitudes towards whistleblowers. The message is to continually emphasise care for others when speaking out about hazards to the public, emphasise fairness when speaking out about corruption, and emphasise liberty — resistance to domination — when speaking out about threats from government or corporate power.

Those three foundations are the easy ones for whistleblowers, namely ones where they have a natural advantage. The other three foundations are more challenging: loyalty, authority and sanctity.

Loyalty to the employer is commonly expected. Whistleblowers violate this sense of loyalty: they are seen as traitors. Are there other ways to assign loyalty to which whistleblowers could appeal? One possibility is loyalty to the mission of the organisation, not to the organisation itself. Of course organisational leaders say they are pursuing the mission, so distinguishing between the mission and the organisation is hard to sell.

you-did-right-thing-wb

Another possibility of an alternative loyalty is to other workers, especially when they are supportive of each other, as in work teams or unions. Instead of speaking out as an individual, a worker concerned about abuses could instead build networks and alliances first, gaining support in order to promote collective action. This is not easy, but does have a prospect of fostering a different assignment of loyalties.

Then there is authority, a moral foundation that whistleblowers almost inevitably challenge. Questioning the boss’s authority is difficult, whether by direct confrontation or by reporting problems to the boss’s boss, higher officials or watchdog bodies. Is there any different line of authority that can be an alternative source of legitimacy? One possibility is the authority of laws. If bosses are violating the law, they are violating legal authority. The trouble is that by the time legal sanctions are applied — if they ever are — it is too late for the whistleblower. After all, corrupt operators do not declare they are breaking the law. Indeed, they commonly allege that whistleblowers are criminals, by violating terms of employment, confidentiality agreements and the like.

One of the advantages of whistleblower laws is that they give legitimacy to whistleblowers. Even though the laws may give little protection in practice and, even worse, give a false sense of security, their very existence may help undermine the assumption that authority is always right.

Red-Queen

Finally there is sanctity, a moral foundation of special significance to many political conservatives. If corruption is stigmatised, then whistleblowers can draw on this moral foundation. This is suggested by the expressions “clean hands” and “dirty hands,” referring to honest and dishonest individuals. Whistleblowers can assist their cause by avoiding any activity that can be easily stigmatised as dishonest or unsavoury. By the same token, employers regularly manipulate the sanctity foundation by trying to stigmatise the whistleblower, by spreading rumours (sexual misbehaviour is a favourite allegation) and by treating the whistleblower as tainted, not to be trusted or even spoken to. Ostracism — cutting off personal relationships — is in essence to treat a person as dangerous and even contagious.

When whistleblowers join together with others, and obtain support from bystanders, it is far more difficult to stigmatise them. There is protection in numbers.

Considering the various foundations of morality thus provides some direction for whistleblowers and their supporters.

  • When appropriate, emphasise violations of care, fairness, and liberty.
  • Search for alternative bases for loyalty and authority.
  • Try to assign stigma to wrongdoers.
  • Be prepared for the tactics used to turn these moral foundations against whistleblowers.

Brian Martin
bmartin@uow.edu.au

More information

I haven’t tried to provide sources for many of the generalisations I’ve made about whistleblowers. For more information see my book Whistleblowing and my site on suppression of dissent.

Acknowledgements

Thanks to Paula Arvela, Don Eldridge, Kathy Flynn, Xiaoping Gao, Steven Howard, Nicola Marks and Tshering Yangden for helpful feedback on drafts.

I am vice president of Whistleblowers Australia but my views here do not necessarily represent those of others in the organisation.

Comments from Kim Sawyer

[Kim was a whistleblower at two Australian universities, and has been active on whistleblowing issues for many years.]

Excellent analysis – corresponds to the thoughts I’ve had over a long period of time. Haidt’s prescription of the rider-elephant dichotomy and the six foundations of morality are insightful. Your application of those foundations to whistleblowing is spot on. Two general comments, and then some specific comments from my experience.

First, whistleblowing acts to elevate the conflict between the foundations. It brings morality into focus for everyone; the whistleblower, the respondent, the bystanders. The foundations are like latent characteristics, and whistleblowing becomes the realization of those characteristics so that an individual has to now make a choice. It’s like going to the ballot box, you have to now choose between fairness and loyalty to the institution.

Secondly, one aspect which could be highlighted more is risk. Everyone, whistleblower, respondent and bystander, assesses their risks. Risk minimization takes over – that is, self-interest. The bystander may see the same unfairness as the whistleblower, but they also see the risk to themselves. You could say that these six foundations are a portfolio, and the whistleblower and bystander assign different weights to different foundations. My sense is that the bystander will always converge to the less risky portfolio which is loyalty to authority.

Some specific comments from my own experience

  1. For me, fairness was always the important factor. In both whistleblowing cases, I chose fairness over loyalty to an unfair authority. And it correlates with my political leanings which are progressive. Of course, there was also a sense of professional responsibility, that a professor should act in the long-term interests of the institution and of higher education in general. Obviously, I took my professional responsibilities too seriously.
  2. The two cases I was involved with highlighted the singularity of whistleblowing, but from vastly different starting points. In both cases though, the institution tried to replace the loyalty of colleagues to me by loyalty to the institution. This strategy emphasises the whistleblower and not the whistleblowing; the weaknesses of the whistleblower and not the foundational issues were highlighted.
  3. Another issue is the conflicting loyalties within the whistleblower. I had loyalty to both universities, but the loyalty was principally to the long-term, not to the short-term management. Whistleblowing involves a lot of internal conflict for a whistleblower between fairness and loyalty to authority. Fairness won out for me.

Pharmacrime and what to do about it

Is the pharmaceutical industry more dangerous than the mafia? Peter Gøtzsche thinks so.

PeterGotzschePeter Gøtzsche

Did you know that the third leading cause of death in western countries, after heart disease and cancer, is adverse reactions to prescription drugs? Did you know that large pharmaceutical companies usually control the trials of their new drugs, and sometimes manipulate the published results by misclassifying deaths, excluding some participants and not revealing studies that came up with null results? Did you know that some of people listed as authors of drug studies published in leading medical journals have had little or nothing to do with the research, have not written the papers, and are paid for their symbolic role? Did you know that several major pharmaceutical companies have paid fines of over one billion dollars for corrupt practice? Did you know that government drug regulators in several countries have become tools of the companies they are supposed to regulate? Did you know that hundreds of thousands of people have died from drugs when the company executives knew about and hid information about the hazards?

This information has been known to critics of large pharmaceutical companies — commonly called big pharma — for many years. There have been powerful critiques written by former editors of medical journals and as well as exposés by whistleblowers. Now there is a new book that puts together the case against big pharma in a more comprehensive and hard-hitting way than ever before: Peter C Gøtzsche’s Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare (London: Radcliffe, 2013).

DeadlyMedicines

The bulk of the book is a critical examination of research findings concerning pharmaceutical drugs, serving to illustrate general points. For example, chapter 4 is titled “Very few patients benefit from the drugs they take,” seemingly a startling claim. Gøtzsche gives some hypothetical examples of how results of drug testing might sound encouraging but actually disguise a very modest effect, and how double-blind trials that are not properly blinded can give misleading results. He then cites studies of antidepressants to show that the actual situation is probably worse than his hypothetical examples.

Different chapters in the book deal with conflicts of interest, pharmaceutical company payments to physicians, drug marketing operations, ghostwriting of articles for medical journals and the inadequacy of drug regulators, among other topics. Each of these chapters includes case studies of particular drugs or company operations. Then come chapters about particular drugs, abuses and companies, for example chapter 14 on “Fraudulent celecoxib trial and other lies.” Gøtzsche exposes corrupt practices, including the hiding of trials that did not show a benefit, disguising adverse drug reactions, promoting a new highly expensive drug that is no better than an existing one, making false statements about the benefits and risks of drugs, applying pressure on drug regulators, and suppressing information about dangerous drugs on the market.

Gøtzsche relies heavily on published studies (including his own) to back up his claims: the book is thoroughly referenced, with numerous citations to articles in medical journals. Deadly Medicines and Organised Crime is in the tradition of rigorous and knowledgeable exposé. Some previous books along the same line include Marcia Angell’s The Truth about the Drug Companies and Jerome Kassirer’s On the Take. Angell and Kassirer had been editors of the prestigious New England Journal of Medicine.

Gøtzsche has impeccable credentials to write a critique of big pharma. He started his career working for a drug company, and saw dubious operations from the inside. He qualified as a doctor and then worked as a medical researcher for many years. Most importantly, he is a key figure in the Cochrane Collaboration, a group of medical researchers who scrutinise the full complement of studies of particular drugs, drawing conclusions about benefits and risks.

Undertaking a meta-analysis of drug trials seems like an obvious thing to do. What makes the Cochrane Collaboration significant is that it is largely independent of the drug industry. The industry’s influence is so pervasive that many trials are fraudulent or misrepresented, many publications are ghostwritten by company staff, and evaluations by drug regulators are biased due to company pressure. Being relatively independent of this influence makes an enormous difference.

As well as obtaining insights from his involvement with the Cochrane Collaboration, Gøtzsche has had personal involvement in trying to influence drug policy. Being from Denmark, on various occasions he has provided information to the Danish drug regulator on crucial issues, such as that a new drug is far more expensive than an existing one, but no more effective. Yet the regulator on many occasions has served drug company agendas by approving drugs, costing the government large sums of money and providing no added benefit to patients.

Here is Gøtzsche’s summary of problems with drug regulation.

We don’t have safe drugs. The drug industry more or less controls itself; our politicians have weakened the regulatory demands over the years, as they think more about money than patient safety; there are conflicts of interest at drug agencies; the system builds on trust although we know the industry lies to us; and when problems arise, the agencies use fake fixes although they know they won’t work. (p. 107)

In describing the unethical and damaging activities of the drug industry, with case after case of egregious behaviour, Gøtzsche sometimes expresses his exasperation. This comes across most strongly in the chapters on psychiatric drugs, many of which are useless or worse, cause addiction and massive damage, yet are widely prescribed due to massive marketing.

Gøtzsche’s book is filled with information and thoroughly referenced, yet perhaps its most striking feature is his claim that big pharma is organised crime, as indicated in the title. At first this may sound exaggerated, or just a metaphor, but Gøtzsche is quite serious. He looks at definitions of organised crime and finds that big pharma fits in all respects: the companies knowingly undertake illegal actions that bring them huge profits and kill people, and they persist in the same behaviour even after having been convicted of criminal activity.

At many points, Gøtzsche asks rhetorically what is the difference between the activities of big pharma in promoting addictive and destructive drugs and the activities of drug cartels producing and selling heroin.

organised-crime-cartoon

Calling big pharma organised crime is in a tradition of pointing to double standards in the way behaviour is labelled. The term “terrorism” is usually applied to violent acts by small non-state groups; some scholars have pointed out that many governments use violence to intimidate populations in way that fits the usual definitions of terrorism. They call this “state terrorism.”

If the operations of big pharma are a type of organised crime, except killing many more people than the mafia, what is to be done? Gøtzsche has a chapter spelling out ways to bring drug testing and regulation under control. One important step is for all drug testing to be done by independent scientists, rather than by the companies that manufacture the drugs. Another is to disallow payments from drug companies to physicians, researchers, medical journals, and regulators. Gøtzsche draws an analogy: what would people think if judges received payments from prosecutors or defendants? It would be seen as corrupt, of course. Company payments to physicians, journals and regulators should be seen as corrupt too.

doctorPayment176

Gøtzsche’s recommendations are sensible and, if implemented, would transform the way drugs are used in society. If this happened, company profits would plummet, which means that companies will do everything possible to maintain the current system. As well as saying what should be done, there is a need for a strategy for bringing about change, and the strategy has to involve citizen campaigners as well as concerned researchers and physicians. Just as the movement against smoking has involved a wide range of campaigners and methods of action, so too must a movement against corruption in healthcare. Deadly Medicines and Organised Crime is not a practical manual for such a movement, but it is essential reading for movement activists, especially so they will know what they are up against.

For readers thinking about their own health, and the health of their friends and family members, Gøtzsche provides important messages. He suggests not taking any drug unless it is absolutely necessary, because benefits are minimal and there are always potential harms. In this category would be included antidepressants and drugs to lower cholesterol and high blood pressure, for example. If you’re going to take a drug, then it’s usually better to take an old one, because newer ones are probably no better, cost vastly more, and are less well tested for harms.

olderisbetter

If you want to know more about the drugs you take, seek independent advice. That’s not easy, because so many researchers, medical journals, physicians and regulators are in the pay of the industry. Reviews by members of the Cochrane Collaboration are a good place to start. So is Deadly Medicines and Organised Crime. Gøtzsche provides enough references for even the most assiduous reader.

Brian Martin
bmartin@uow.edu.au

 

I thank Melissa Raven for useful comments on a draft of this comment.