User:Cat2120330347/Medical-industrial complex

The Medical-Industrial Complex is a network of interactions between pharmaceutical corporations, health care personnel, and medical conglomerates to supply health care-related products and services for a profit. The term is a product of the Military–industrial complex and builds from the basis of that concept.

Term
The Medical-Industrial Complex was first coined in Barbara Ehrenreich's 1969 book titled "The American Health Enterprise: Power, Profits, and Politics." She uses ideas surrounding medical care and how many patients are viewed as objects that need to be fixed as opposed to human beings with a complex need for care. This concept was largely discussed throughout the 1970's and 80's and further popularized with increases in literature surrounding the topic, particularly in The New England Journal of Medicine. The term is centered around the idea of a For-profit hospital, and how they interact with patients, physicians, and pharmaceutical companies to increase health costs.

Within the United States
The Medical-Industrial Complex is intertwined with the workings of the United States's near-fully privatized healthcare industry.

Healthcare Corporations
Healthcare corporations are connected with the creation of chain hospitals. A chain hospital is a form of Hospital network that works under a for-profit goal of expanding healthcare and establishing hospitals across a country, most notably the United States. These corporations set standards regarding care administration, regulation, and enforcement without fully acknowledging Medical ethics and their consequences.

Chain hospitals combined with conglomerate pharmaceutical companies lead to an increase in the price a patient will pay for a single hospital visit. Not only will this increase be felt throughout their visit, but the chains of lifelong medications can also have lasting influence.

Pharmaceutical Company Influence
Pharmaceutical companies are a leading influence in the expansion of the Medical-Industrial Complex. Generic pharmaceutical drugs, which have the same chemical properties as branded, profitable drugs, are sold for a fraction of the cost of their counterparts. For example, a 10mg dose of asthma medication Singulair can cost up to $250 per month, whereas its generic counterpart Montelukast can cost up to $20 per month. These inflated prices contribute to a worsening health climate where patients can barely afford their monthly medications. This creates long-term cycles of poverty and lack of resources for patients and those who depend upon them.

Pharmaceutical companies also produce bias in physicians and other health care professionals. Not only do pharmaceutical companies go to physicians to directly promote their product, but research performed with pharmaceutical company-funding is more likely to produce favorable results. This suggests that pharmaceutical companies can produce bias in physicians and the studies that support physicians's choices. These effects manifest in physicians, who are more likely to prescribe an expensive drug over a generic alternative if they are familiar with the drug brand.

Laboratory tests are also within reach of pharmaceutical company influence. Physicians are more likely to order unnecessary tests when they are connected with pharmaceutical companies. Not only this, many companies set these tests at an inflated price in an effort to increase profit.

Chain Healthcare Influence
Chain hospitals, in collaboration with pharmaceutical companies, lead to the escalation of health costs. Chain hospitals and other healthcare conglomerates hold a monopoly over healthcare costs within their hospitals and respective subsidiaries. Thus, they can inflate healthcare costs with the goal to increase profit, or lower hospital standards to cut corners where necessary. Hospitals in one state can be monitored by systems elsewhere, which give significantly less power to local healthcare professionals. Standards set by chain hospitals also set compliance rules, disclosures, and regulations that can oftentimes become unattainable by healthcare professionals. Overall, chain hospitals are structured with a goal of profit in mind that often disregard the physicians that play a front-line role in treatment, prevention, and detection. Chain hospitals are often associated with for-profit hospitals.

Continuing Medical Education
To continue practicing as a board-certified physician, which most hospitals require, a physician must take a Continuing Medical Education course. Continuing medical education is a program that ensures physicians are up-to-date with recent medicine and programs, also giving them board certification if they pass the test. These courses are often sponsored by pharmaceutical companies and healthcare corporations, who can instill Bias in physicians. For example, if a course was sponsored by an ultrasound device brand, like Butterfly, then the tests and coursework would frame Butterfly in a positive light. When physicians complete the course, they will then be more likely to use Butterfly, even if it is unnecessary for a patient's treatment. Likewise, even if the physician does not use Butterfly, they will have to become familiar with it in order to pass the exam. This Conflict of interest can affect how a patient is treated and how much they have to pay in return for their treatment. Healthcare corporations also sponsor these events to promote tests that may exhibit physician bias. One example of this is a physician choosing Test A over Test B, because they were trained in the effectiveness of Test A. In reality, Test A is much more expensive than Test B and can achieve the same results as Test B.

There are entities that work to reduce bias in Continuing Medical Education. Groups such as the Accreditation Council for Continuing Medical Education work to make the program as fair as possible, and multiple Medical education agency work to reduce this as a whole.

Bias in Education
Medical students, as part of their curriculum, are often expected to read from large Medical journal organizations, like The New England Journal of Medicine. These large journals can unknowingly produce bias in their publishings. A Peer-reviewed journal can even be subject to bias, because many large studies are often funded by healthcare corporations or pharmaceutical companies. These publishings can inherently promote one expensive treatment over another, less-expensive treatment, even if they may yield the same results. Likewise, the cost of treatment in large medical journals is rarely mentioned. New treatments are often labelled as "low-cost," as opposed to clearly giving the average cost of an exam to a patient. Avoiding specific information about how healthcare can affect a patient's quality of life, either through healthcare cost or potential side-effects, supports the separation between physician and patient. Physicians must be cognizant about a patient's financial standing, and how likely they can pay back expensive medical care. Not only this, prescribing expensive medications can in-debt a patient for the rest of their life, and physicians should take medication cost into account when treating a patient.

Consequences
The Medical-Industrial Complex poses unique difficulties for patients and physicians. Diseases like chronic illnesses, or a Chronic condition, can tie a patient to the Medical-Industrial Complex throughout their entire life. Likewise, a terminal illness can force a patient to accept their soon passing, but also deal with the consequences of the illness and how they must pay for it.

Patient-level
A health professional offers a unique to service to patients, since patients are oftentimes completely vulnerable to their care provider. Likewise, a patient needs unique, reliable help especially in situations where they are physically, emotionally, and sometimes financially vulnerable. Many healthcare corporations exploit this vulnerability and can often in-debt patients as an exploitation. For example, if a person is involved in a car accident and becomes unable to communicate, they are taken to the nearest hospital. Thus, they cannot refuse nor accept medical treatment. For patients who do not have access to reliable health insurance, this imposes expensive medical treatment that they must pay for.

For patients with a chronic illness, diagnosis often means expensive medications for the rest of one's life. Chronic illnesses like depression may require medications throughout one's lifetime until the illness is treated, whereas more severe chronic illnesses like cystic fibrosis require expensive medical and pharmaceutical treatments for one's entire life. These diseases could be treated but their unique long-lasting nature means money can be generated from life-long treatments as opposed to an end-all treatment.

Physician-level
Physicians are subjective to the Medical-Industrial Complex and its manifestations. Throughout the 21st century plastic surgery has become more common, where people have surgeries performed to solve a cosmetic issue. Cosmetic surgeries are often used to satisfy a certain beauty standard. An example of this is a rhinoplasty, which is oftentimes a purely cosmetic surgery that is not life-saving or necessary for quality of life. For-profit healthcare introduces the idea of nonessential healthcare, that can oftentimes create more problems than are solved. For-profit healthcare promotes non-essential healthcare services so that more profits can be created from healthy populations.

The phrase "no margin, no mission" is often used to describe for-profit healthcare, where medical centers will adapt to corporate interests so they can stay in business. For physicians, this can mean not treating uninsured patients, performing unnecessary procedures that can generate profit, or supplying better care to patients that have a better means of pay.

Corporate entities also enact standards over compliance rules, disclosures, and regulations. These rules disregard the ethical and moral dilemmas that physicians often face, setting unattainable standards on situations that cannot be determined by a clause. Not only this, insurance companies also enforce rules and regulations surrounding medical treatment and payout. Physicians are often tied between healthcare corporations and insurance companies determining what they can and cannot do for a patient, where it is necessary or not.

Many pharmaceutical and medical device companies are investor-based, meaning that if a device or drug receives FDA approval the physician will be financially invested in its success or demise. Thus, a physician who is financially involved in a product or service is more likely to promote or utilize the product, whether or not its efficacy is known. This provides a complex conflict of interest for physicians and patients, who may not get as effective, safe treatment due to physician bias for one product over another.

Laws and Policies
The Dalkon Shield was an IUD introduced in the late 1970's and 1980's. The long-term effects of using this device were not well known, and the device ended up being very ineffective and dangerous, leading women to become pregnant or having severe complications. The manufacturers of this device said that their IUD was safer than other forms of birth control available, and none of their reports noted potential safety issues. When the device was discontinued after CDC and FDA investigations, the IUDs were not recalled and still produced dangerous complications for women who had them. This shows the dangerous background of the complex and prioritizing profit over the safety and wellbeing of patients. Likewise, because this device did not prevent pregnancy, many fetuses with severe birth defects were born. The long-term effects of this device were not properly investigated and contributed to the dangerous medicine on the market.

The Safe Medical Devices Act of 1990 was passed by the FDA as an amendment to the FDCA and requires the manufacturer to report information about medical devices contributing to death, sickness, or injury. This also allows healthcare professionals to report malfunctioning, unsafe medical equipment

Within India
The complex also is present in India, where the Indian Medical Association lobbies for their interests at the local and state-level in politics.