Cleaveland: Who will speak for the people

Cleaveland: Who will speak for the people

February 11th, 2010 in Health

In 1980, Dr. Arnold Relman, then editor of The New England Journal of Medicine, warned of the growing hazard of a "medical-industrial complex." He coined the term to represent the steadily increasing economic and political influence of providers of medical services. He included physicians, medical centers, pharmaceutical companies and device-makers in the complex.

Dr. Relman worried that a powerful medical-industrial complex would promote overuse of technology. Services to patients would be increasingly fragmented. Easy profits might drive diagnosis and treatment.

At the time of his editorial, health care costs for our country totaled $253 billion or 8.8 per cent of gross domestic product (GDP). Ten years later the health care bill had almost trebled to $714 billion or 11.9 per cent of GDP. For 2008 the numbers were $3.2 trillion and 16.2 per cent of GDP.

Since 1980, medical centers, training programs, and physicians have become progressively more entwined with corporations that develop and market drugs, medical devices, and a variety of commercial services. Medical journals depend upon ad revenue from corporations. Most clinical research is funded by the same enterprises.

Last year, health-related enterprises employed more than three thousand registered lobbyists -- six per Congressman -- to represent their interests in Washington. For the year, lobbying costs exceeded half a billion dollars, the first time such costs had reached this mark for any business sector. In addition a further $210 billion was spent on television ads related to the issue of health care reform. Companies or organizations favoring change spent $100 billion. Groups opposed to change spent $85 billion. The remainder of the money bought neutral ads.

Makers of drugs and other health-related products spent $245 million for lobbying in 2009. Hospitals and nursing homes spent $99 million. Health professional organizations added $82 million.

Lobbyists include many former aides to Congressmen and committees involved in health-care legislation.

Millions of additional dollars from health-related businesses support re-election campaigns of Congressmen who are especially influential in health issues. Contributions of hundreds of thousands of dollars have been made to United States senators and representatives of both parties. Profiles of campaign gifts to each Congressman can be accessed at

In January the Supreme Court, in a five to four ruling, dramatically altered restrictions on campaign advertising funded by corporations, unions, and other organizations. Unlimited funds can now be directed to candidates, whether legislative or judicial, who would be sympathetic to the views and needs of companies, institutions, and professional groups involved in health-related businesses. Vital agencies such as the Food and Drug Administration could easily be neutralized by legislators whose elections depended upon unlimited campaign donations from the medical-industrial complex.

Against this background, do the concerns and experiences of an individual citizen matter? Over the years I have written, and more recently e-mailed, my Congressional representatives when I felt strongly about certain health-related issues. In most instances I received no response. Are these comments read? If so, who reads them? Are statistical analyses performed on opinions from individuals? Does a writer have to be a campaign contributor to assure that his or her comment will be acknowledged? Must each of us join advocacy groups which can contribute to campaigns to assure that shared views will be heard?

Congressional offices are deluged with e-mails, phone calls, and requests for meetings with groups and individuals. Nevertheless, I believe that the viewpoints of individuals matter. We must have assurances from our elected officials that our letters are read and taken seriously. Otherwise we become a government of, by, and for corporations and special interest groups

Contact Clif Cleaveland at