Welcome to the Chutzpah Hall of Fame, the Health Care Version. These awards honor those organizations whose audacious pursuit of their own interests makes the less audacious among us marvel. Here are the inductees for 2005.
Third runner-up: Philip Morris, reborn as Altria
Philip Morris makes zillions making lots of people very sick. Breathing noxious stuff into our lungs hurts our bodies. So does sitting around people breathing the noxious stuff: Epidemiologists have documented the impact of "secondhand smoke" on nonsmokers.
Not surprisingly, public health gurus have been battling nicotine largely by banning smoking. Again not surprisingly, smoking is down, particularly among teenagers in the United States. What is an entrepreneurial giant to do?
Philip Morris hit upon a solution: Make inhalers. The legions of people with breathing problems (many because of secondhand smoke, or lifetimes of smoking) rely on inhalers, but those are not optimal delivery tools. Depending on the person's skill, the inhaler may inhale only a fraction of the medication. So Philip Morris wants to make super-duper devices.
Of course, public health gurus are appalled: Dr. Doom is morphing into Dr. Kildare. What chutzpah!
But Philip Morris does know how to get stuff efficiently into lungs. And these super-duper devices may help a lot of people. So it gets third runner-up.
Second runner-up: pharmaceutical-funded charities
How marvelous that pharmaceutical companies help the uninsured get their medications! Surely those companies belong in a Philanthropist Hall of Fame, not the Chutzpah one.
Yet consider the mechanism of that philanthropy, as detailed in the Wall Street Journal (Dec. 1, 2005). A company donates to a nonprofit foundation to pay for the health insurance of somebody who is sick and uninsured, and who needs a very expensive drug regimen. The pharmaceutical donor may contribute as much as $6,000 a year to pay the insurance tab. How generous! Yet in return the donor may net as much as $50,00 a year, when the insurer picks up the tab for a costly regimen. Philanthropy helps not just the recipient, but the donor. The donor shows a net return on the investment/gift. Just as crucially, that gift helps the company maintain high drug prices -- which consumers ultimately pay for via premiums.
Charities can mask self-interested motives -- whether via support for the executives and consultants who make their living by promoting the cause (such as Bill Frist's AIDS charity, World of Hope, as described by Associated Press Dec. 17), or support for political causes (such as the DeLay/Native American imbroglio). The pharmaceutical companies that profit from their largesse are following a tradition.
Since these charities do help sick Americans get insurance, though, the chutzpah has a beneficent component. The companies get second runner-up.
First runner-up: Bush administration, for melding science, religion
Science is messy -- a process of trial and error, with hypotheses begetting more hypotheses. And scientists often disagree. So the federal government, which funds most research, relies on teams, often contentious ones, of experts for guidance.
The Bush administration has larded those teams with people who spurn the scientific method, relying on their interpretation of Divine Will to settle thorny questions. Should we allow stem cell research in labs? The morning-after contraceptive pill in pharmacies? Charles Darwin in biology texts? Look at the governmental edicts, and then look at some of the people behind those edicts. Those bureaucrats and appointees may be well-meaning advocates of their world-view, but they are not primarily scientists. Investing them with the authority to make decisions vis-a-vis science is like putting scientists in charge of religious synods.
Yet, if science is messy, so is democracy, and these bureaucrats and appointees come out of the democratic process. So this chutzpah doesn't take the prize.
States take the prize for their use of tobacco settlement money.
Remember the mega-million-dollar tobacco case settlement? States claimed that decades of smoking had made citizens sicker and that tobacco companies should pay up. Moribund witnesses and distraught families testified. The settlement was supposed to shore up services for ex-smokers, to deter would-be smokers, to pay for health care. That was the logical, expected benefit.
Last year states collected $21.3 billion from the 1998 settlement and state tobacco taxes; states spent $551 million on health care. Most of that money went for construction and capital campaigns, and to relieve strained budgets. No enhanced health care for anybody. That is chutzpah.
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email firstname.lastname@example.org.