Medical–industrial complex
The medical–industrial complex refers to a network of interactions between pharmaceutical corporations, health care personnel, and medical conglomerates to supply health care-related products and services for a profit. The term is derived from the idea of the military–industrial complex.
Following the MIC's conception in 1970, the term has undergone an evolution by critical theory scholars throughout the early 21st century—including the fields of disability studies, Black studies, feminism, and queer studies—to describe forces of oppression against marginalized communities as they exist in the healthcare field. Prior to the conception of the "medical-industrial complex" term, themes related to the MIC were discussed in earlier American society, as shown through the work and philosophies of Rana A. Hogarth and Francis Galton.
The medical–industrial complex is often discussed in the context of conflict of interest in the health care industry and is often regarded as a result of modernized healthcare and capitalism. Discussions regarding the medical-industrial complex often concern the United States healthcare system, and propose that pharmaceutical and healthcare companies, including for-profit chain hospitals, may influence physicians' decisions through financial incentives. Physicians may also face constraints from corporate regulations and potential conflicts of interest related to investments in medical device companies. Although some large medical journals have been criticized for potentially biased publications, efforts have been made to maintain neutrality in medical literature. Continuing medical education programs funded by pharmaceutical companies may also influence physician preferences. Finally, patients may be affected by the MIC through the promotion of cosmetic surgery, drug price inflation, and physician bias. The Food and Drug Administration has implemented laws to protect patients against the potential negative impacts of the medical-industrial complex in the United States. These perspectives on the medical-industrial complex also apply to countries outside the United States, such as India and Brazil.
Drawing from diverse theoretical frameworks and the collective efforts of historically marginalized communities, critics have proposed alternatives to the medical-industrial complex that aim to reimagine health as a holistic concept, challenge the medicalization of sickness, and integrate lived experiences into healthcare settings.
Origin
In his 1961 farewell address, President Dwight D. Eisenhower commented on the influence and immensity of the military in American society: "...we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex." This new term, the military-industrial complex, depicts a sphere of influence between a national military and the defense industry which provides essential supplies to the military. Deriving from this, the compound term composed of the intended institution with "industrial complex" is created to describe the conflict of interest between an institution's supposed goal, and the desire to profit from the businesses/agencies that profit from serving the institution. The conceptual framework of the medical-industrial complex sits alongside the military-industrial complex and the prison-industrial complex, among others, to delineate the influence of free market capitalism in sociopolitical systems and institutions.The concept of a "medical–industrial complex" was first advanced by Barbara and John Ehrenreich in the November 1969 issue of the Bulletin of the Health Policy Advisory Center in an article entitled "The Medical Industrial Complex" and in a subsequent book, The American Health Empire: Power, Profits, and Politics. In "The Medical Industrial Complex," the emergence of the American medical industrial complex is attributed to "the growing rapport between the delivery and products industry." This definition of the medical-industrial complex describes the history of the American healthcare system, specifically the creation of social programs Medicare and Medicaid, as an industry that has transformed into a central, essential role of the American national economy. References to the perpetuation of healthcare disparities by the medical-industrial complex are described, such as "class and cultural antagonisms." Differences in accessibility of healthcare between rural and urban populations are also made at this time.
In 1980, Dr. Arnold S. Relman published a further discussion of the medical-industrial complex in The New England Journal of Medicine when he was editor-in-chief, entitled "The New Medical-Industrial Complex." Relman notably explicitly excludes pharmaceutical companies and medical equipment companies in his description of the medical-industrial complex. Relman argues that "in a capitalistic society there are no practical alternatives to the private manufacture of drugs and medical equipment." Relman still identifies the novelty of the modern medical-industrial complex, describing the medical-industrial complex as an "unprecedented phenomenon with broad and potentially troubling implications." As with the Ehrenreich definition, the medical-industrial complex continues an emphasis on profit maximization on behalf of private corporations. The "cream-skimming" phenomenon is described, where proprietary hospitals can "skim the cream" off the market, by focusing on wealthy patients who can afford the most profitable procedures and services; nonprofit hospitals are therefore left with the remaining patient base.
In the 21st century, the medical industrial complex has come to encompass a system of oppression and subject of critical analysis by scholars, activists, organizers, and advocates. The Health Justice Commons describes the medical-industrial complex as intertwined institutions, including big pharma, as well as health insurance companies, medical technology companies, and governmental regulatory bodies. Per the Health Justice Commons, the medical-industrial complex reinforces "racism, sexism, classism, homophobia, transphobia and ableism." The nature and extent of the medical-industrial complex is a subject of debate by scholars, including those who specialize in fields of critical theory, such as disability studies, queer theory, and Black studies. According to encyclopedia.com, the Medical-Industrial Complex has "contributed to improvements in the health status of the population" but "it has also strengthened and preserved the private sector and protected a plurality of vested interests."
History
The existence of the medical-industrial complex as a concept is a product of the development of the modern American healthcare system. In the 19th century, the profession and practice of medicine underwent significant professionalization and growth. Experimentation on enslaved people was common. Doctors such as gynecologist J. Marion Sims operated on enslaved black women without anesthesia in order to document and develop gynecological medical issues and techniques to repair them. The creation of hospitals to treat the sick create further disparities in favor of urban, white populations.The contemporary American healthcare system was shaped by the passage of the Hill-Burton Act, Medicare, Medicaid, and most recently, the Affordable Care Act. The latter social programs attempt to diminish the disparity of populations with difficulties maintaining health insurance, but does not attempt to reduce the private sector. The medical-industrial complex endeavors to reconcile the modern healthcare establishment with the long term health inequalities.
Some elements of the medical-industrial complex, including the experimentation on marginalized populations, were introduced much prior to the modern American healthcare system. The conglomerate as it is now known is the synthesis of the modern healthcare system with developed capitalism.
1780 - 1840
In the historical monograph Medicalizing Blackness: Making Racial Differences in the Atlantic World, 1780-1840, Rana A. Hogarth discusses "the ways in which blackness was reified in medical discourses and used to perpetuate notions of white supremacy," and, consequently, harm and oppression. For example, Hogarth discusses how "white physicians constructed images of healthy and robust black bodies capable of enduring brutal labor regimes" while also identifying "deficiencies within these bodies that disqualified them for self-government." Importantly, Hogarth argues that oppression of black individuals using science predates the justification of slavery, and, instead has more to do with the origins of the medical industrial complex that allowed for the "intellectual, professional, and pecuniary gains" of physicians in the English-speaking greater Caribbean region over those of black individuals.1900s - Present Day
Eugenics has played a prominent role in the history of the MIC. The term eugenics was introduced in 1904, by Francis Galton. It was defined as "the science which deals with all influences that improve and develop the inborn qualities of a race" with the goal of "represent each class or sect by its best specimens, causing them to contribute more than their proportion to the next generation." Galton's concept of eugenics soon propagated ideas that certain groups of people, whether they were distinguished by race, ability, or socioeconomic status, were superior to others. Renowned journals, such as Nature, published work by Galton and other eugenicists, thereby making it easier for eugenics to become a legitimate field in science.Some instances of eugenics are infamous in society, such as the justification of the mass ethnic genocide of Jewish people during the Holocaust by arguing that society was in need of racial purification.
Other examples of eugenics, such as the selective abortion of children with disabilities, are more controversial. Other notable eugenic-like practices include compulsory sterilization of black and poor individuals and scientific racism.
For more, see eugenics.