Cascading incentives

Dr David Healy, towards the end of a long article entitled The Eclipse of Medical Care, summarises how medical science has been eclipsed: 

1. Clinicians do not have access to clinical trial data on medicines or vaccines.
2. Close to all of the medical literature reporting trial results for on-patent drugs and vaccines is ghostwritten, hyping the benefits and hiding the harms.
3. Clinical trials of these treatments that are negative on their primary or their most common outcomes are often published in prestigious journals as positive.
4. Clinical trials have their harms airbrushed out of ghostwritten publications.
5. Regulators (FDA, Health Canada, MHRA, EMA) do not get to see the full trial data.
6. Regulators approve treatments as working even when more people die on active treatment than on placebo.
7. Regulators approve medicines on the basis of negative studies and agree not to let the wider world know about this.
8. Regulators say nothing when companies publish negative studies as positive and make adverse effects of treatment, including death, vanish.
9. For many trials there are more deaths on active treatment than on placebo, but this does not lead regulators to warn about hazards as to do so would in their stated view deter people from seeking a benefit (even when the benefit is better characterized as a commercial benefit to a company rather than a benefit to the individual in terms of a live saved or a restoration of function).
10. Regulators do not have pharmacovigilance expertise and a variety of factors inhibit them from linking a treatment to a hazard after that treatment comes on the market. 

The Eclipse of Health Care, David Healy, 29 November

This is typical of the sort of corruption that blights so many of our public- and private-sector bodies. How does this happen? Often cited is regulatory capture which occurs when a regulatory agency that is created to act in the public interest, instead advances the commercial or political concerns of special interest groups that dominate an industry or sector the agency is charged with regulating. But why does that happen? 

I do think that there's been an erosion of trust is western societies, but that is subjective and does not point toward an actionable solution. So I'd like to suggest that, rather than rely on nebulous mission statements to guide our public-sector agencies (or an apparently weak moral compass), we instead focus on the outcomes that society as a whole wishes to achieve. In this example, then, medical care would be subordinate not to the goals of the organisations supposed to supply it, but to the broader and more meaningful goal of the health of society's health. 

Doing so using the Social Policy Bond concept would replace organisations' goals (essentially that of self perpetuation) with those of society. Incentives to improve society's health would cascade downwards from that over-arching goal.These incentives, as under the current system, would largely be financial, but that does not mean that the people responding to them be entirely motivated by greed. Rather, it means that they would find a way of making a living compatible with society's goals, the goals of the bodies for which they work, and ethical behaviour. 

For a short piece on how the Social Policy Bond concept can be applied to health, see here. For a longer treatment, see here.