A Practitioner's View of Institutional Corruption Through the Lens of the Health Care System

Abstract

This essay examines institutional corruption – how the behavior of individuals can change dramatically when lulled into complicity under the guise of institutional allegiance. It argues that institutions have a way of corrupting even those who are inherently principled, often through corporate compliance and integrity programs designed to lead employees to believe that impropriety is actually impossible. The key argument in this essay is that where impropriety is orchestrated from the top and is integral to the corporation’s business model, no internal compliance and ethics programs will be equipped to halt the wrongdoing – they may in fact be designed that way. Taking the example of pharmaceutical companies marketing drugs off-label, it suggests that buying influence over the standard of care is the ultimate goal. Patients or prescribing doctors are pushed to make decisions based on a standard of care that is tainted by corporate interest, and perhaps unwittingly, patients are put at unnecessary risk for minimal, if any, benefit. Pharmaceutical companies deputize sales representatives to encourage off-label prescription by instructing them that the very practice of off-label marketing is illegal – convincing representatives that their conduct must be legal if the corporation itself is directing the practice. The essay concludes with a series of policy suggestions to increase corporate accountability, particularly within the healthcare sector – an industry most at risk for fraud and corruption.