The dangers of ‘political capture’ for clinicians and scientists

The influence of politics on scientific endeavours, including funding, prioritization and public messaging, is not new. COVID-19 has resulted in polarization and politicization of pandemic related issues, especially related to scientifically promoted mitigation measures.

The “Freedom Convoy” protests and occupations speak to a growing divide in Canada between scientific and political dialogue and what defines “truth.”

Another trend that the pandemic has uncovered is increasing “political capture” of clinicians and scientists, especially public health physicians. We rely on these individuals to communicate to the public, at times on a daily basis, pandemic information, and evolving emergency measures.

“Political capture”, also called “state capture”, is “the domination of policy making by private, often corporate, power.”

This is similar to the concept of “regulatory capture,” defined as “… an economic theory that says regulatory agencies may come to be dominated by the industries or interests they are charged with regulating. The result is that an agency, charged with acting in the public interest, instead acts in ways that benefit incumbent firms in the industry it is supposed to be regulating.”

I offer an alternate definition: “The domination of scientists, clinicians and other content specialists by their political masters.”

Clinicians and scientists must avoid becoming the scapegoats for the consequences of government decisions.

And it is this political capture that clinicians and scientists, when advising government and especially when functioning as senior civil servants, must avoid or become the scapegoats for the consequences of government decisions.

Prior to the pandemic, many would have been hard-pressed to name or identify their Chief Medical Officer of Health (CMOH). Now, due to constant media attention, most Canadians instantly recognize their CMOH and could identify the CMOHs of other provinces or territories.

CMOHs, including the Federal Chief Public Health Officer (Theresa Tam), serve as senior civil servants and at “the pleasure of the Minister.” The advice they give government is protected under the umbrella of “cabinet secrecy.” Cabinet secrecy allows governments to receive candid advice in confidence from various sources to assist them in making policy decisions. The downside is that the CMOH cannot publicly disclose what advice has been given to the government without the minister’s permission.

In part, this is because public health is just one source of information that governments consider when making health-policy decisions. Governments shape policy decisions using many other lenses such as economics, legal, ethics, public opinion, etc. Final policy decisions are a mélange of multiple considerations that are rarely fully communicated to the public.

The risk is that governments will oversimplify their final decision as “we are following the advice of our medical experts” who cannot verify if this is the case or not.

This is not unexpected as politicians understand that physicians and scientists are considered more trustworthy sources of information versus politicians.

But the public may overestimate the power of their public health leaders as was suggested by a Toronto Sun front page headline – “Doctatorship” (March 18, 2021). The associated column stated:

… Thanks to politicians wanting to ensure that every decision they make has cover, they, and we in the media, have elevated the position of public health doctors to that of omnipotent god instead of what they really are, medical advisors.

In a democracy such as ours, there is no way that unelected doctors should wield so much power and authority, enough to force us to close schools, businesses, change our entire way of life. Yet, that is where we are in Ontario thanks to a system deeply in need of reform

“I’m going to be very frank. There’s no politician in this country that is going to disagree with their chief medical officer. They just aren’t going to do it. They might as well throw a rope around their neck and jump off a bridge. They’re done,” Ford said.

If this is the case in Ontario it is a dangerous situation as politicians should be ultimately responsible, and accountable, for their decisions and not hide behind their medical advisors.

The relationship between the CMOH and government is quite different in Alberta where the CMOH, Deena Hinshaw, appeared to be in the dark when Premier Jason Kenney announced ending public health orders on June 15, 2020. Hinshaw is quoted saying: “I haven’t had the opportunity to have that conversation so I think that might be a question best addressed to the premier in terms of that particular information”

It has been uncommon, during the COVID pandemic, to have a public health official so clearly direct the press to the government for answers. This should happen more often.

Another way of serving a government agenda of “kicking the can down the road” is to appoint prominent medical advisors and leaders as heads of various “task forces.” This provides a buffer for politicians to defer comment, or engagement, as the “task force is working hard on the issue, and we await their recommendations.”

An example is the Manitoba Diagnostic and Surgical Recovery Task Force that was struck in May 2022 and tasked to find new solutions to address the backlog in care that resulted from the COVID-19 pandemic.

The public can become confused and lose trust when task force leads disagree publicly with other health-care leaders.

It is interesting to note that the same government created the MB Wait Times Reduction Task Force in 2016 that produced a more than 300-page report with recommendations in 2017. Obviously, implementation, or non-implementation, of the recommendations did not prepare MB for the stress COVID-19 put on its health-care system, being the only province to transport more than 50 ICU patients out of province.

In addition, the public can become confused and lose trust when task force leads disagree publicly with other health-care leaders on health policy issues. This is happening in MB where the President of Doctors MB, Kristjan Thompson, and Peter MacDonald, Chair of MB’s Diagnostic and Surgical Recovery Task Force, are at odds about what metrics to use to measure the magnitude of the province’s diagnostic and elective procedure backlog. As reported by CBC:

MacDonald said the task force doesn’t entirely agree with the numbers compiled by Doctors Manitoba. The task force is working with the doctors’ group to try to verify those numbers, he said. 

“We both acknowledge that there’s pitfalls in the methodology on both sides,” he said, noting wait times may be a more important metric to patients than a broad number representing the backlog.

“When you look at the backlog numbers, they’re very daunting. And then when you talk to the front lines, you get a different story in some areas,” MacDonald said.

Asked what current wait times are, MacDonald said “there’s a huge spectrum of procedures” and varying urgency levels. The task force “has a good idea” on average wait times for most procedures but it would take some time to gather that. (Darren Bernhardt, CBC March 30, 2022)

Thus, pollical capture can adversely affect clinicians and scientists in a number of ways including becoming scapegoats for unpopular political decisions (e.g., blamed for the imposing or lifting emergency measures), compromising ethical standards (e.g., questionable validity of government messaging), eroding public trust (e.g., government-imposed lack of transparency) and eroding credibility (e.g., criticized as being partisan).

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5 Comments
  • Nancy L says:

    Being a citizen and not in the profession of Healthcare I am deeply concern, and noticing the validity of your article. I can’t help but feel that our Universal Healthcare Plan is slowly being dismantled and undermined by corporations and politicians.
    Speaking of capture I hope this website remains a Healthy Debate, and free from capture.

  • Patrick Fafard says:

    Interesting and provocative commentary. Much to agree with including the critical observation that we have to emphasize how mistaken it is to see the CMOH as the person who makes the decisions about major policy choices during pandemic – this is the responsibility of those we elect. The role of CMOH/CPHO has been placed under enormous strain over the past few years. In some places (e.g,, Quebec) this led to the CMOH resigning. In others (e.g., Alberta) Dr. Hinshaw has been left to defend very controversial policy decisions and has been indirectly blamed by the government she works for. But the core argument of “political capture” does not hold up. First, all CMOHs are public servants, some serve at the “pleasure of the Crown” but others are regular public service appointments. They all have a duty to loyally serve the government of the day. In the real world of policy making it is not so much “politics” against “science” or against the public service but rather a system designed, as suggested, to bring a range of considerations to bear. Second, the CMOH role is very unusual insofar as it is also designed to be something of an independent and autonomous source of advice (with important variations between jurisdictions). The credibility of government decisions, so the theory goes, is enhanced if the public sees that it is informed by the advice of somewhat independent experts. But putting the CMOH in the media spotlight week after week and asking them to not just explain the science but defend the policy choices has compromised their autonomy, real and perceived (again with important variations between jurisdictions). In the long run this weakens the utility of the role. Finally, in the post-pandemic inquiries we need to think about changes to the role of the CMOH/CPHO. It may no longer be possible or desirable to have one role that is simultaneously, science expert, advisor, senior executive, government spokesperson, and the semi-autonomous voice of public health.

  • Dr. Rob Murray says:

    The lack of a universal Pharmacare program in Canada is a good example of corporate capture.

    Another way corporations have gained control of medicine is by controlling clinical practice guidelines. Guidelines exist to assist physicians and serve patients and are not to unduly restrict clinical judgment. They are recommendations and clinical tools that should support, not subvert clinical judgment. They must be patient-centred, as patients are the end users; they are not mandates to be used by Royal Colleges to punish those that don’t conform.

    The current International Diseases Society of America [IDSA] Lyme disease guidelines do not have a legitimate purpose and were used by the Institute of Medicine [now NAM] as a poster child of what not to do. They (1) excluded divergent viewpoints, 2) handpicked their evidence, 3) didn’t screen for conflicts, and 4) held up copycat guidelines [by the American Academy of Neurology] as independent when they were not, 5) demonstrated over-reliance on expert opinion. The IDSA Lyme guidelines purpose is to harm physicians who didn’t follow the guidelines and to restrict treatment to 14 days using a single bacteriostatic agent no matter what the stage of the disease.

    The insurance industry made a concerted effort to deny coverage for the disease. They enlisted the help of doctors who were researching, not treating, Lyme, paid them large fees and together developed arbitrary guidelines for testing the disease. Once these arbitrary guidelines were decided, the insurers denied coverage for patients if they did not meet their new stringent Lyme disease testing protocols. These doctors have since served as expert paid witnesses

    These physicians agreed to change the disease description so Lyme became only a minor nuisance disease, easy to diagnose and treat. They have since served as expert paid witnesses to decline treatment and health benefits to patients claiming to be suffering from persistent Lyme disease.

    The disease is defined so narrowly and the bar set so high that few can pass. Sick patients don’t care about textbook pure definitions and can’t wait for tomorrow’s research.

    Because the IDSA guidelines do not provide for treatment options or the exercise of clinical judgment by physicians and fail to acknowledge the existence of divergent treatment approaches, the Canadian Royal College of Physicians and Surgeons, medical societies, government agencies, courts and insurance companies may view them as a mandatory standard of care which they are not.

    Insurance defendants use the Guidelines as a predatory device to injure doctors who do not follow the guidelines. The IDSA Guidelines also prevent doctors from providing patients with proven treatment options because the IDSA Guidelines are extremely restrictive and they also limit patients’ ability to obtain health care and eliminate patients’ choice of medical treatment. Royal Colleges in Canada routinely penalize doctors by investigating them if they fail to follow the IDSA guidelines, which can be costly to the patients that need the disfavoured protocol.

    Family doctor’s ignorance is frequently mixed with reasonable fear: treating Lyme patients in Canada, especially advanced cases with persistent Lyme, may cost a doctor his or her license. The provincial Colleges of Physicians and Surgeons can enforce this national policy of Lyme denial by investigating anybody that doesn’t conform to protocols and to the rigid IDSA guidelines even though the guidelines themselves say they are not mandatory and our courts have agreed that they are voluntary. It is always of help to have a well-informed patient.

    IDSA and the Association of Medical Microbiologists and Infectious Disease [AMMI] Canada claim that their guidelines are evidenced based but we have to point out that you just can’t cherry-pick the bits you want while disregarding everything else. It is important for people to realize that when they hear medical or public health professionals proclaim that the medical guidelines dictating the practice of medicine and insurance reimbursement for Lyme disease are based on the best available science; such assertions are rhetorical hyperbole and little else.

    The IDSA/AMMI has regularly shown it ignores scientific evidence and distorts interpretations of research findings on one hand, while giving far too much credence to poorly designed low-level studies in order to justify its position on the other. Throughout medical history, new effective ideas and treatments are at first denied then ridiculed and finally accepted as self-evident. The fact is that denying, downplaying and trivializing Lyme has happened from the earliest days when we first became aware of its presence in Canada and when it became endemic in the 1980’s and evidence is being spun to fit an agenda.

    Who gets to say what is evidence anyway? If it is only their opinion than they shouldn’t be calling it evidence.

    IDSA guidelines do not define the legal standard of care and are not rules. They are meant to be coloured by the physician’s interpretations of the patient’s individual circumstances. The Canadian courts have agreed with this interpretation. “The courts have always made it clear that a doctor need not follow the procedures adopted by a unanimous majority of doctors. If a doctor follows a procedure adopted by a reputable minority of practitioners, it will suffice to disprove any inference of negligence.”

    Patients and their health care providers should be given treatment choices when they are available. The IDSA guidelines have nothing useful to say about the reality of the disease and the actual experience of those that have it.

    The defining characteristic of corruption in modern medicine is the abandonment of the patient’s interest. Patients are often road-kill on the highway to profit.

    This is a medical system divided against itself. Adherents to the dominant medical opinion are willing for various ideological reasons to let people perish. We may never know how many Alzheimer’s, ALS, MS or Parkinson’s deaths might really have had a preventable bacterial origin. It simply doesn’t seem fair.

  • Dr. Rob Murray says:

    Physicians in the U.S. think of themselves as business men and women but, because most Canadian doctors don’t charge their patients directly they think of the profession as being untainted and somehow better than those that do.

    On October 24, 2017, the United Nations [UN] Special Rapporteur [SR] on the right to health, Dainius Pūras, presented his report on corruption to the UN General Assembly. He told his audience, “In many countries, health is among the most corrupt sectors; this has significant implications for equality and non-discrimination “… He noted some are related to the global pharmaceutical industry and others from “institutional corruption” and emphasized the “normalization” of corruption in healthcare which includes practices undermining medical ethics, social justice, transparency and effective healthcare provision, as well as illegal acts. Many researchers and scholars support the SR’s findings.

    Physicians and the public hold the CDC in high regard and expect impartial unbiased leadership, but this may have to be reassessed. The CDC accepts funding from industry lobby groups, which raises some serious conflict-of–interest concerns. Marcia Angell, former editor-in-chief of the New England Journal of Medicine, told The BMJ “The CDC has enormous credibility with physicians, in no small part because the agency is generally thought to be free of industry bias. Financial dealings with biopharmaceutical companies threaten that reputation.”

    According to the BMJ article by Jeanne Lenzer published in May 2015: “The CDC does receive millions of dollars in industry gifts and funding, both directly and indirectly, and several recent CDC actions and recommendations have raised questions about the science it cites, the clinical guidelines it promotes, and the money it is taking.” Allowing corporations, institutions and medical organizations to help fund the CDC Foundation could in large part have led to the current problems with Lyme management in North America and globally, including its diagnosis and treatment.

    Canada, along with other countries agreed to fund the CDC and follow its lead in disease such as Lyme. The paradigm of modern medicine is to palliate with treatments that give the pharmaceutical industry life-time annuities. Shareholder preferences control things and shareholders are no longer interested in cures, vaccines or new antibiotics. Medicine has lost its way and there are too few medical sleuths looking for the root cause of disease. Historically infection has usually been found to be the root cause. The advent of powerful, profitable immunosuppressants allows the pharmaceutical industry to fund, research, medical schools and political parties.

    In Canada we see an example of corporate capture with the separate organizations of Public Health Agency of Canada [PHAC], CIHR, PHN, Health Canada and AMMI [Canada] speaking with one voice on the Lyme disease file. Lyme was mis-categorized as a minor nuisance disease in 1994 when the long-term disability insurance industry red-flagged it as being too expensive to treat. Once a disease is labelled as somatoform or idiopathic then all investigative efforts cease and patients are given an inferior diagnoses. This problem goes right to the top of PHAC.

    • Dr. Sandor Demeter - original article author says:

      Thank you for your comments

      Noting that I am in no way an expert on Lyme disease, chronic or otherwise, I agree that industry capture of health practitioners or health institutions is also a real issue and possible threat.

      For example, there are good examples of pharma exerting pressure on academic institutions relative to the release of research findings as well expressed opinions (e.g., sagas of Dr. Olivieri – U of T – Apotex and Dr. Healy – U of T – Lilly) . Canadian author Katherine Fierlbeck discusses this in her book; Katherine Fierlbeck, Health Care in Canada A Citizen’s Guide to Policy and Politics (Toronto: University of Toronto Press, 2011). She also co-edited a book called Transparency, Power, and Influence in the Pharmaceutical Industry (2021).

      So I agree it is not just “political” masters that can capture scientists, clinicians (and health care institutions). However, the strategies they use may not be as direct as “…you serve at the pleasure of the Minster.”

Authors

Sandor J. Demeter

Contributor

Sandor J. Demeter, MD, MHSc, MSc, MHP, FRCPC, is an associate professor at the University of Manitoba, Rady Faculty of Health Sciences, College of Medicine, Department of Community Health Sciences.

sandor.demeter@umanitoba.ca
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