1. Corporate Control of Public Health: Case Studies and Call to Action Martin Donohoe

2. Am I Stoned? A 1999 Utah anti-drug pamphlet warns: “Danger signs that your child may be smoking marijuana include excessive preoccupation with social causes, race relations, and environmental issues”

3. Corporations Dominate the Global Economy Almost 6 million corporations 90% of transnational corporations headquartered in Northern Hemisphere 500 companies control 70% of world trade

4. Corporations Dominate the Global Economy 53 of the world’s 100 largest economies are private corporations; 47 are countries – Wal-Mart is larger than Israel and Greece

5. The Stock Market The top 1% of Americans owns 35% of all stocks, bonds, and mutual fund assets Consequences of Differential Stock Ownership – Corporations are answerable to their shareholders – Governments are answerable (at least in theory) to their citizens (either through elections or revolutions)

6. Corporations Internalize profits – $2.1 trillion (2013) Externalize health and environmental costs

7. Corporate Taxation Corporations shouldered over 30% of the nation’s tax burden in 1950 vs. 8% today Nearly 1/3 of all large U.S. corporations pay no annual tax

8. Corporate Taxation Big business claims that U.S. corporations pay the highest corporate taxes in the world (35%) FALSE: The rate actually paid, after foreign governments get their cuts, money sent to foreign subsidiaries, loopholes, etc. = 2.3% (U.S. Treasury Department)

9. Reasons for Inadequate Corporate Taxation Corporate tax breaks/loopholes Corporate welfare Cheating and under-payment common Offshore tax havens shelter capital

10. Ugland House, Cayman Islands 18,000 Corporations Registered Here

11. Job Creators?

12. Corporate Taxation 2004: Bush administration offered temporary tax holiday on foreign earnings – $300 billion in profit repatriated 92% went to dividend payouts, stock buybacks, and corporate coffers Only 8% went to R and D, new factories, and hiring

13. Exorbitant CEO Pay The average CEO makes 331X the salary of the average U.S. worker (1960 - 41X) – Mexico 45:1 – Britain 25:1 – Japan 10:1 – US Military: 20:1 (top rank : lowest rank) – US ratio of average CEO to minimum wage worker = 774:1

14. Exorbitant CEO Pay Median U.S. CEO salary (for S and P 500 corporations) = $11.7 million (2014) CEO salaries up 937% since 1978 – Average worker pay up 10%

15. Exorbitant CEO Pay The average CEO makes 250-400X the salary of the average U.S. worker (1960 - 41X) – Mexico 45:1 – Britain 25:1 – Japan 10:1 – US Military: 20:1 (top rank : lowest rank)

17. The Mega-Rich Worried / Investing in personal security – Bodyguards – Armored cars – Bullet-proof windows; machine gun proof doors – Home security fogs – Panic rooms – Fully-stocked home medical suites – Yachts with escape submarines – Islands

18. Corporate PR Tactics Advertising – “The art of convincing people to spend money they don't have for something they don't need.“ (Will Rogers) Astroturf - artificially-created grassroots coalitions Corporate front groups Corporate espionage: spying, bribes

19. Corporate PR tactics Invoke poor people as beneficiaries Characterize opposition as “technophobic,” anti-science,” and “against progress” Portray their products as environmentally beneficial despite evidence to the contrary Host all-expense paid educational seminars for federal judges

20. Public Relations $200 billion industry PR flacks now outnumber journalists

21. Greenwash Public relations / ad campaigns – BP invests $100 million annually in clean energy = amt. it spends annually to market itself as moving “Beyond Petroleum”

22. Sponsored Environmental Education Materials (Examples) International Paper -“Clearcutting promotes growth of trees that require full sunlight and allows efficient site preparation for the next crop” Exxon’s “Energy Cube” -“Gasoline is simply solar power hidden in decayed matter” -“Offshore drilling creates reefs for fish”

23. Sponsored Environmental Education Materials (Examples) American Coal Foundation’s “Power from Coal”: – “The earth could benefit rather than be harmed from increased carbon dioxide.”

24. Academics/Professional Organizations Affected Increasing corporatization of academia – For-profit schools – Charter schools – Educational corporations

25. Academics/Professional Organizations Affected – ↑Private commercial funding of university research Front-end domination and rear-end repression affect research agenda, dissemination of knowledge Undone science Secrecy/gag clauses

26. Academics/Professional Organizations Affected For-profit colleges growing, marked by corruption, high interest rates on loans to the un- and under-qualified – Benefit largely from taxpayer money Dramatic decrease in tenured faculty, rise in administrators Gagging of researchers at federal agencies demoralizing, can affect recruitment of quality scientists

27. Union of Concerned Scientists (2015)

28. The Media 5 corporations control majority of US media (down from 50 in 1983) Extensive corporate-media links

29. Global Warming: Controversial? Of 928 articles in peer-reviewed scientific journals, none were in doubt as to the existence or cause of global warming Of 636 articles in the popular press (NY Times, Washington Post, LA Times, WSJ), 53% expressed doubt as to the existence (and primary cause) of global warming Science 2004;306:1686-7 (Study covers 1993-2003)

31. Lobbying Approximately 40,000 lobbyists (11,781 full-time) Estimates of return on lobbying range from $28 to $100 for every $1 spent

32. Lobbying Federal lobbying groups spent $3.2 billion in 2014 All single issue ideological groups combined (e.g., pro-choice, anti- abortion, feminist and consumer organizations, senior citizens, etc.) spent well under $100 million

33. Top-Spending Industries, 2014 Pharmaceutical industry - $230 million Business Associations - $163 million Insurance industry - $151 million Oil and gas industry - $141 million Computers/Internet - $140 million Electric utilities - $122 million

34. Campaign Cash and Lobbying Citizens United McCutcheon v. Federal Election Commission Lobbying promotes international non- cooperation/isolationism

35. Case Studies

36. The alliance between GE Medical Systems and NY-Presbyterian Hospital

37. General Electric Ranked by Forbes as world’s largest company (based on equal weighting of sales, profits, assets, and market value) 2014 revenues of $149 billion – Close to the GDP of more than 2/3 of U.N. member states 2014 net after-tax profits of $15.2 billion Majority from overseas operations

38. General Electric Makes household appliances, lighting, and medical equipment – Plastics division, which produced bisphenol A, spun off in 2008 Produces jet engines and military hardware

39. General Electric Charles Wilson (CEO of GE pre- and post-WW II; helped oversee U.S. military production during WW II): – “The revulsion against war…will be an almost insuperable obstacle for us to overcome. For that reason, I am convinced that we must begin now to set the machinery in motion for a permanent wartime economy.”

40. General Electric Has built 91 nuclear power plants in 11 countries (including the troubled Fukushima Daishi plants in Japan) – Including 23 plants at 11 sites in U.S. e.g., Hanford – ¼ of GE’s US reactors found to be defective

41. General Electric Operates coal-burning power plants – Major releasers of toxic mercury Produces nearly 40 technologies used in fracking – Increasing investments in fracking

42. General Electric Operates a large financial services group – Responsible for over 50% of company’s profits in recent years – 2015: company plans to sell off majority of GE Capital (now Syncrhony Financial) over next 2 years – Under investigation by the Justice Department for over potential bankruptcy violations

43. General Electric Until recently, owned 49% of a multi- billion dollar media empire – Including NBC, Telemundo, and Universal Studios – Comcast owned 51%; bought out GE in 2013

44. GE’s History Conducted unethical human subject experiments on prisoners, involving testicular irradiation, from 1940s to 1960s Intentionally-released excessive radiation from its Hanford, WA nuclear reactor in the 1980s, to determine how far it would travel

45. GE’s Record Sued radiologist who brought to light dangers of GE’s contrast agent, Omniscan – Causes nephrogenic systemic fibrosis (FDA black box warning) Ordered to pay $11.4 million to Bracco Diagnositcs for falsely/misleadingly claiming that its x-ray contrast agent Visipaque was superior to BD’s Isovue

46. GE’s Record America’s largest corporate polluter 116 Superfund sites nationwide Approximately 13 in NY

47. GE’s Record Between 1947 and 1977, two of its capacitor manufacturing plants dumped at least 1.3 million pounds of PCBs into the Hudson River – Probable human carcinogens with adverse effects on liver, kidney, nervous system, and reproductive organs (EPA) – 200 mi of Hudson = Superfund site

48. GE’s Record Eliminated 34,000 US jobs between 2000 and 2010 Added 25,000 overseas jobs over same period – One of nation’s top out-sourcers of jobs

49. GE’s Record Cited by Human Rights Watch for “systematic workers’ rights violations” in the U.S. and abroad Extensive record of tax violations, military procurement fraud

50. GE CEO Jeffrey Immelt 2014 total compensation = $37.2 million (up from $25.8 million in 2013) Named “World’s Best CEO” in 3 separate Barron’s polls 2006 - 2011 - On Board of NY Federal Reserve Bank

51. GE CEO Jeffrey Immelt 2008 – Named one of the “100 Most Influential People in the World” by TIME Magazine 2009 - Appointed by President Obama to his Economic Recovery Board – GE then became eligible, via a loophole, for ¼ of the $340 billion Temporary Liquidity Guarantee Program (debt support)

52. GE CEO Jeffrey Immelt 2011 - Appointed by Obama as Chair of his outside panel of Economic Advisors and of his Council on Jobs and Competitiveness On the board of directors of “The Robin Hood Foundation”!

53. GE’s Record Named “America’s Most Admired Company” by Forbes Named one of the “World’s Most Respected Companies” in polls conducted by Barron’s and The Financial Times

54. Concerns About the Agreement between GE Medical Systems and NY-Presbyterian Hospital (2003) Provides GE with financial incentives to promote high technology purchases Hospital prohibited from purchasing more effective equipment from other companies

55. Concerns About the Agreement Augments trend in academic medical centers to promote the use of expensive, high- technology care at expense of preventive care and public health measures – Highly reimbursable – Services may be redundant in certain locations

56. Concerns About the Agreement Patients with developmental anomalies and cancers caused by GE’s pollution diagnosed with GE scanners and treated with GE-manufactured therapeutic devices, increasing GE’s profit

57. A macabre twist on “cradle to grave care”

58. The American Council on Science and Health Corporate Front Group Promulgates unsound science Pro-corporate agenda Major media presence – Medical director spent time in federal prison for Medicaid fraud, perjury, and obstruction of justice Threatened to sue me, Medscape over allegations in article on global warming

59. WHO Tobacco Treaty U.S. attempted to undermine treaty through Bush administration appointees with strong ties to tobacco industry

60. Medical Technologies Industry Successful lobbying effort against Medicare physician payment policies relevant to unproven imaging studies Whole body CT scans (scams)

61. Drug Testing 2011: Florida Governor Rick Scott (R) issues executive order requiring drug tests on current state workers and new applicants 2011: Scott signs bill requiring drug tests for TANF program – positive test allows parent to choose another individual to receive benefits on behalf of children – Aid recipients responsible for cost of tests

62. Drug Testing Florida Governor Rick Scott – Former CEO of Columbia/HCA – Fired after presiding over massive Medicare fraud that cost corporation $1.7 billion federal fine – Then set up Solantic (FL chain of emergency care clinics); transferred ownership to his wife upon entering statehouse Solantic is in the drug-testing business!

63. Corporate Agribusiness Successful campaign against Oregon’s Proposition 27 (labeling of GM foods) Lobbying for pre-emptive labeling laws re GMOs, rBGH

64. Corporate Agribusiness Supports spread of GMOs to developing world Keeps GM seeds from non-corporate academic researchers Promoting agriculture bills which provide large subsidies to large industrial farms

65. Prison-Industrial Complex Construction and management of prisons Providing (substandard) health care to inmates

68. Health Insurance Industry Dubious practices: – Delisting – Cherry picking – Pre-existing conditions Often lower quality of care High administrative costs – 15-30% (vs. 2-3% for Medicare and Medicaid)

69. Health Insurance Industry Large profit margins Loyalty: shareholders (not patients) Corruption

70. Medical Care Sponsor luxury care consortiums, clinics Facilitate medical tourism Participation in “medical transfer market” (facilitates medical repatriations of undocumented immigrants - e.g., MexCare)

71. Corporate Agreements with Medical Associations AAP – Abbott Nutrition (manufacturers of Similac) AAP – Babies “R” Us AAFP – Coca Cola, Inc. AMA – Sunbeam AMA – sells access to Physician Masterfile

72. Pharmaceutical Industry Limited innovation – 90% of new drugs little or no better than existing agents (“me too drugs”) and only 1% offer improved care for life-threatening conditions Improved somewhat recently

73. Drug Companies’ Cost Structure Manufacturing – 35% Marketing – 27% Profits (after taxes) – 18% R and D – 13% Taxes – 7%

74. Pharmaceutical Industry Influence over physicians through control of CME, gifts, research funding – Over $3.7 billion to at about 366,000 physicians and 900 teaching hospitals in 2014 (excluding research funding) – Physician Payments Sunshine Act – reporting requirements

75. Pharmaceutical Industry Conduct seeding trials to alter prescribing patterns Secrecy, statistical torturing of data sets, selective publication Data mining of prescribing practices Unethical trials in developing world Poor compliance with Clinical Trials Registry rules

76. Drug Company Malfeasance The pharmaceutical industry is the biggest defrauder of the federal government, as determined by payments made for violations of the federal False Claims Act (FCA) – Accounted for 25% of all FCA payouts between 2000 and 2010 – Defense industry – 11%

78. Pharmaceutical Industry Avoided $7 billion in US taxes in 2012 by shifting profits overseas $230 million dollars spent on lobbying in 2014 – 2.3 lobbyisits for every member of Congress – Revolving door between legislators, lobbyists, executives and government officials

79. Pharmaceutical Industry Effectively lobbied and threatened trade sanctions against developing countries in order to prevent production and importation of much cheaper, generic versions of life-saving anti-AIDS drugs Patent extensions Promotion of agricultural antibiotic overuse

80. PPACA Patient Protection and Affordability Care Act Career arc of Elizabeth Fowler (architect of plan): – VP for Public Policy and External Affairs (informal lobbying) at WellPoint (nation’s largest insurer) – Chief health policy counsel to Senator Max Baucus (who drafted legislation) – Head of Global Health Policy at pharmaceutical giant Johnson and Johnson

81. Other Areas of Corporate Malfeasance Military-industrial complex Energy and chemicals industry Law enforcement/prison-industrial complex Payday loan industry Genetically-modified crops/biopharming Breast milk substitutes

82. Solutions Restructure tax system Improve regulation of banks (e.g., enforce Dodd Frank law) Punish corporate scofflaws with large fines and jail time – Hide no Harm Act (pending in Senate) would hold corporate officers criminally accountable if they knowingly concealed serious dangers that led to consumer or worker deaths or injuries

83. Solutions Increase enforcement budgets to combat corporate crime Eliminate confidential legal settlements and confidential business information relevant to public health and safety Eliminate mandatory binding arbitration clauses

84. Solutions Living wage laws Work with corporations – Benefit corporations – Healthy PR – Shareholder activism – Risks/benefits

85. Solutions: Fair, Representative Elections Publicly financed campaigns and campaign finance reform Open debates, free air time for candidates Proportional representation Instant runoff voting/cumulative voting/range (rating) voting Halt disenfranchisement, overturn voter restriction laws

86. Solutions: Vote US voter turnout low Wealthy vote at almost twice rate of poor Whites > Blacks > Hispanics Old > Young Property owners > Renters Physicians < general population

87. Voter Turnout

88. Solutions Activism / Letter writing / Protesting / Whistleblowing Join community groups – become involved in local as well as national issues Lobby legislators Run for office

89. Solutions Increase funding of public education Independent scientific review of school curricula Prohibit use of sponsored curricula

90. Solutions Establish safeguards re corporate involvement in academic research Higher standards of journalism Support alternative media

91. Solutions Augment and improve international aid package Sign, ratify, and adhere to major international treaties

92. Solutions Based on Precautionary Principle Recognize nature’s net worth Calculate prosperity based on Genuine Progress Index or Global Happiness Index, rather than Gross Domestic Product

93. “All men are created equal” – Declaration of Independence “Some people are more equal than others” – George Orwell

94. Voltaire “The comfort of the rich rests upon an abundance of the poor”

95. Hudson River, 2009

96. Primo Levi “A country is considered the more civilized the more the wisdom and efficiency of its laws hinder a weak man from becoming too weak or a powerful one too powerful.”

97. Günter Grass “The first job of a citizen is to keep your mouth open.”

98. African Proverb If you think you are too small to have an impact, try going to bed with a mosquito in your tent

100. Contact Information and References Public Health and Social Justice Website http://www.publichealthandsocialjustice.org http://www.phsj.org martindonohoe@phsj.org