{"id":31843,"date":"2014-06-27T10:50:41","date_gmt":"2014-06-27T09:50:41","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=31843"},"modified":"2014-06-27T10:51:06","modified_gmt":"2014-06-27T09:51:06","slug":"the-bmj-today-troubling-statistics-and-calls-for-sweeping-reforms","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2014\/06\/27\/the-bmj-today-troubling-statistics-and-calls-for-sweeping-reforms\/","title":{"rendered":"The BMJ Today: Troubling statistics\u2014and calls for sweeping reforms"},"content":{"rendered":"

\"peter_doshi\"<\/a>The BMJ<\/em> has published some recent statistics that are more than a bit disconcerting.<\/p>\n

The first set regard\u00a0corruption. Surely hard to measure, but \u201cbest estimates are that between 10% and 25% of global spend on public procurement of health is lost through corruption,\u201d Anita Jain, Samiran Nundy, and Kamran Abbasi write in an Editorial<\/a>. In the US, the figure is $82 billion to $272 billion. Even the low end of this estimate is an enormous sum.<\/p>\n

It would be nice if a few bad apples were driving the bulk of this corruption, but Jain and colleagues suggest that the problem is at least partly structural. In India, for example, \u201cthe payment of bribes or use of influential connections . . . has become ingrained in people\u2019s attitudes.\u201d They call for an international fight against kickbacks.<\/p>\n

The second troubling statistic is a ranking.<\/p>\n

In 2013, the Bill & Melinda Gates Foundation was the largest financial contributor to the World Health Organization\u2019s budget, explains Devi Sridhar<\/a>, a population health researcher and lecturer, in The BMJ<\/em>‘s talk medicine Podcast. I had to rewind to make sure I heard that right. But I had. In 2013, the Bill & Melinda Gates Foundation contributed more to WHO\u2019s total budget than any member state.<\/p>\n

Perhaps I shouldn\u2019t be surprised. It is a bit like the recent statistic that Apple and Microsoft both have larger cash reserves than the UK and many other nation states.<\/p>\n

But we are talking about the World Health Organization here, and if not surprised, then I should at least be alarmed as I am certain that sometime during my elementary school education I was taught that the United Nations and its agencies were about the agenda of nation states. Yes, some states were more powerful than others, but it was still about nation states.<\/p>\n

Sridhar goes on to explain that only a small percentage\u2014she says 8%\u2014of the funds are being given in a flexible way, meaning that the vast majority of WHO\u2019s funds may be earmarked by donors. Herein lies the real problem.<\/p>\n

\u201cIt looks [like] an international institution, but it\u2019s actually being used to achieve individual government or small group goals, or the Gates Foundation goals, while giving the appearance and branding of being the WHO,\u201d Sridhar says.<\/p>\n

Is this reason enough to give up on WHO?\u00a0 In their Analysis article<\/a>, Sridhar, along with Harvard School of Public Health dean Julio Frenk, Georgetown University ethicist Larry Gostin, and Harvard lecturer Suerie Moon, stress WHO\u2019s \u201cunique political legitimacy,\u201d and argue for increasing WHO\u2019s core budget. \u201cWHO is the only international agency that can broker global rules that protect the health of all, but is badly underfunded to perform this core function.\u201d<\/p>\n

Meanwhile on bmj.com<\/a>, with 30 rapid responses posted<\/a>, debate remains hot over whether evidence based medicine is in crisis<\/a>. Also in steady stream, are readers\u2019 criticisms<\/a> of a recent Research article<\/a> on the nature and direction of association between decade old FDA warnings about antidepressants and suicidal behavior.<\/p>\n

Peter Doshi<\/strong> is an associate editor for The BMJ.\u00a0<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

The BMJ has published some recent statistics that are more than a bit disconcerting. The first set regard\u00a0corruption. Surely hard to measure, but \u201cbest estimates are that between 10% and […]<\/p>\n

More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[447,5750,1357],"tags":[],"class_list":["post-31843","post","type-post","status-publish","format-standard","hentry","category-india","category-the-bmj-today","category-us-health-care"],"yoast_head":"\nThe BMJ Today: Troubling statistics\u2014and calls for sweeping reforms - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2014\/06\/27\/the-bmj-today-troubling-statistics-and-calls-for-sweeping-reforms\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The BMJ Today: Troubling statistics\u2014and calls for sweeping reforms - The BMJ\" \/>\n<meta property=\"og:description\" content=\"The BMJ has published some recent statistics that are more than a bit disconcerting. 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