ISSN 1662-4009 (online)

ESPE Yearbook of Paediatric Endocrinology (2020) 17 13.1 | DOI: 10.1530/ey.17.13.1

ESPEYB17 13. Global Health for the Paediatric Endocrinologist Advocacy, History and Society (5 abstracts)

13.1. Corruption in global health: the open secret (personal opinion)

García PJ


School of Public Health, Cayetano Heredia University, Lima, Peru patricia.garcia@upch.pe


To read the full abstract: Lancet 2019; 394: 2119–24. doi: 10.1016/S0140-6736(19)32527-9

• The author is a physician and has served as Health Minister in her home country, Peru.• She reviews the role of leaders in low-resource settings in the development of corruption and extends her comments to high-resource environments.• She discusses 6 types of corruption: absenteeism, informal payments from patients, theft of money, supplies and medications, corruption in service provision, favouritism, and manipulation of data.

This opinion article emphasizes the magnitude and cost of corruption in global health and raises several important issues that we are all facing, sooner or later, knowingly or unknowingly, in our daily practice. How can paediatric endocrinologists ensure that they are not part of the problem and, in addition, that they are part of the solution?

This opinion given by Dr Garcia in her article brings to my mind two examples of difficult situations often faced by paediatric endocrinologists. A first example is the uneasy relationship between the pharmaceutical industry and the paediatric endocrinologist. Over the last 25 years, in order to decrease the conflict of interest between the pharmaceutical industry and the trainees/staff members, ethical rules in North America have prevented perks that used to be common, such as invitations to the annual meeting of professional societies (including flights, meals, registration, and accommodation). While the system is not perfect, in high-income countries, strong institutions and other sources of funding such as universities, non-industry grants or personal resources have made it possible to keep attending many of these precious annual conferences. In low-income countries, where alternative sources of funding are not available and physician’s salaries are low, rejecting industry support is much more difficult and leads to difficult choices. How can we ensure that paediatric endocrinologists in low- and high-income countries benefit from the same opportunities? A second example is the lack of access to medicines in many low-income countries (and sometimes also in high-income countries). Why is the medicine that was just prescribed to our patient unavailable, unaffordable or of unsuitable quality? A lack of transparency in the many steps of the process that brings the medicine from the manufacturer to the patient (i.e. cost of production, registration and distribution, tender process, quality control, contracts between various players) plays a major role. Paediatric endocrinologists could and should play a major advocacy role in getting full transparency. While we may think that poor access to medicines is exclusively limited to low-income countries, this is not the case. For instance, a recent BMJ article reports that in August 2019, ASPEN UK admitted taking part in an anticompetitive arrangement by illegally paying two competitors to secure a monopoly for the distribution of fludrocortisone in UK. This resulted in an 1800% increase in the price paid by the National Health Services (NHS) in UK for fludrocortisone (from 1.5 to 30 GBP for 30 tablets of fludrocortisone). In addition to paying a fine of 8 million GBP, ‘Aspen has promised to ensure that in the future there will be at least two suppliers of fludrocortisone in the UK to help the NHS obtain better prices’ (reference). As proposed by Dr Garcia in her article, we need to develop ‘new models that could work to fight against corruption in global health, and to funders to support this effort’.

Reference:

1. Iacobucci G. Drug firms colluded to hike fludrocortisone price by 1800%, says watchdog. BMJ 2019;367:l5881.

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