White Suits: The Nexus

If the Tuskegee runners could be CDC, then there's nothing left to surprise in the US-led medical system: except that now and then we do get the glimpse of a horrible truth, a sick megaprofit industry lying behind, through films like The Constant Gardener or The Verdict, or through such reports: http://www.sciam.com/article.cfm?id=a-medical-madoff-anesthestesiologist-faked-data

The problems are manifold, and they start with the unholy nexus between practitioners, pharma companies and researchers. From the ground level, a medical rep knows who is prescribing what and in that proportions the reward is given. In India, it could be cartels of wine, a holiday at Bangkok with 'girls', and so on; the same holiday-makers are respectable wise-looking men in white suits, who you think as God. Problems go deeper in the Western world: because of a show of concern for accountability. Hospitals could be church-run ones, or important components of medical colleges: even if something wrong is found out, the argument is why to lose years of credibility, why let the trust get eroded over 'one small thing'? After all, they easily persuade themselves, by remaining quiet we're only doing a larger good: and the perpetrator is just given a silent rap on the knuckles. One is caught, the other thousands are not.

The problem with Scott Reuben kind of fraud is that a token measure like that of Johns Hopkins (http://www.bloomberg.com/apps/news?pid=20601202&sid=aIvIUq6pvKS8&refer=healthcare) won't really help: Reuben hasn't taken any gift, he was just on 'research grants', paid directly to him. Payment through institution would simply mean a more rampant corruption, nothing else. What would help is that medical institutions stop the race for new breakthroughs, newer and more effective and more fast-working medicines, and stop keep getting in news and publications: there is not that much research needed.

Almost everyone does a PhD now. Research on a myriad of irrelevant topics. Of course then they come up with strange conclusions: with a motley group of 20, they even conclude that "bondage sex is good for you" or "your heart", whatever. Newspapers of a certain bias and tabloids who think everything is on a frivolous par in this world pounce upon such news items: and along with the WAG who bared it all, the pop singer who again has a paedophilia hearing, the sportstar who hit a goal yesterday, and the social worker who brought out a rally in support of some displaced community and an actress who turned vegetarian, we also have a researcher who finally brought on the benefits of some kinky activity. What kind of research are we paying funds for? What kind of education system is it that teaches men to publish, regardless of whether there's trash inside or gold, better if trash?

A problem lies also outside of the immediate medical framework: the publishing world. Publishers want anything: anything which libraries lap up, and which is written by someone cited a lot, and with a very good 'About the Author' to write on the blurb. As long as that need is getting served, they will take anything. To fool you into believing that they are conscientious guardians of information, they will set up an elaborate peer review system. A blind process. They will find out through contacts or just a Google search (horrible!) some names who seem to have worked or know something about that particular stream, and contact those with offers of reviewing. Very few reviewers do their job: for others, it's simply different things. From as bad as maybe greedy even about the honorarium payment, to reading greedily the manuscripts so that they can 'learn' of latest advances and pinch later for their own dream manuscripts, to simply feeling good about themselves without thinking are they really qualified or not, knowledgeable enough or not. Why was Scott Reuben's false data not caught in peer review? Or maybe someone did question, but the publisher just wants a minimum number of favourable peer reviews, doesn't it? And then it can go gung-ho.

The whole problem is that we laid down frameworks and systems and policies so that we can use them as checklists and be right: we can come to each position and then check against those and see oh whether we are safe. But what is really happening is this: we start by ticking off the items in the checklist. We start with "can we be safe here?" and then we just somehow manipulate the thing to be safe on the checklist: the checklist has become the god. Because we're no longer interested in what we started for, why we started for, we have forgotten our burning ideals of youth and childhood and everything: we just want more impact factor, more citations, more awards, more honor, more medicines, more billions of dollars that help elect in more and more presidents, more big brands and bigger diseases!