"Corruption in the pharmaceutical sector occurs throughout all stages of the medicine chain, from research and development to dispensing and promotion," the fact sheet reads.

The medicine chain refers to each step involved in getting drugs into the hands of patients, including drug creation, regulation, management and consumption. According to WHO data, unethical practices such as bribery, falsification of evidence, and mismanagement of conflicts of interest are "common throughout the medicine chain."

The fact sheet also highlights other forms of corruption specific to particular steps in the chain. For example, clinical trials may be conducted without proper regulatory approval, royalties may be collected through manipulation or disregard of the patent system, and products may be registered with incorrect or insufficient information.

Drugs may be produced through substandard or counterfeit methods, leading to products that are less effective at best, and hazardous at worst. Corruption can also occur during the drug inspection process, allowing such shoddy products to be given a government seal of approval.

Once drugs have been produced for the market, corruption can occur via the selection of non-essential drugs for different governments' lists of "essential" medications. Unethical marketing strategies -- both legal and illegal -- are common throughout the drug business. Vendors may collaborate with pharmaceutical companies and doctors might be unduly influenced to dispense drugs to gain the greatest profit rather than to produce the greatest benefit for the patient.

This corruption can have serious consequences, the WHO warns.

"Medicines are only beneficial when they are safe, of high quality, and properly distributed and used by patients," the fact sheet says.

Most obviously, corruption in the drug business can divert medicines away from where they are most needed, while the production of substandard pharmaceutical products can be dangerous to patients' health.

"Diverted, counterfeit and substandard medicines have been identified in markets of both rich and poor countries," the fact sheet says.

"Such practices lead to patient suffering and have direct life or death consequences."

Corruption in the drug business also wastes public resources and "[erodes] public and donor confidence in public institutions." In Third World countries, as much as 89 percent of health care spending is lost to corruption, while unethical practices cost First World countries an estimated $12 billion to $23 billion a year. Worldwide, this amounts to a loss of 10 to 25 percent of all drug procurement spending, or nearly $190 billion.

The WHO notes that corruption is so widespread in part because medicines pass through a large number of intermediaries before they reach the patients who need them. Each extra step provides an opportunity for corruption to take place, ultimately driving up the cost of the medicine or diverting it toward the wrong recipients.

Corruption is especially hard to fight because most cases go unreported. The WHO attributes this both to fear of retaliation on the part of whistleblowers, and also the institutionalization of corruption "to the point where people feel powerless to influence change in their countries."

According to the WHO, countries most likely to be plagued with corruption in the pharmaceutical industry are those without "appropriate legislation or regulation of medicines; enforcement mechanisms for laws, regulations and administrative procedures; [or] conflict of interest management."

"A lack of transparency and accountability within the medicines chain can also contribute to unethical practices and corruption."

Corruption has real health impacts, the fact sheet emphasizes. For example, countries with more corruption have higher child mortality rates than other countries with similar health standards.

As part of its efforts to reduce unethical practices in the medicines chain, the WHO launched the Good Governance for Medicines program in 2004. This program helps countries evaluate their vulnerability to corruption, then plan and implement programs to reduce it.

www.sott.net/articles/show/207738-WHO-Issues-Warning-About-Corruption-of-Pharmaceutical-Industry