Worst Health Care Revolving Door Case So Far, Version 2.0? – From President of Lilly USA to US Secretary of Health and Human Services?

By Roy Poses, MD, Clinical Associate Professor of Medicine at Brown University, and the President of FIRM – the Foundation for Integrity and Responsibility in Medicine. Originally published at Health Care Renewal

Last week, we discussed what appeared to be the most egregious case of the health care revolving door seen so far.  A health care corporate lobbyist without any direct medical, health care, public health or biomedical science experience was named Acting US Secretary of Health and Human Services after being confirmed as Deputy Secretary.

Former Top Executive of Pharmaceutical Company Eli Lilly Considered for Nomination as Secretary of Health and Human Services

Only a week later, an even more egregious case may be in the works.  The name being “floated” as nominee to be the next Secretary of Health and Human Services is Mr Alex Azar, who through this year was a top pharmaceutical executive.  Again, he has no experience in medicine, the health professions, public health or biomedical sciences.

To repeat, you cannot make this stuff up.

As reported by Politco on October 17, 2017

Azar has spent most of the past decade inside the drug industry, one of the key sectors he’ll regulate at HHS. Azar joined pharmaceutical giant Eli Lilly and Company in June 2007 as a senior vice president of corporate affairs and communications right after leaving the Bush administration.

He rose to head Lilly’s U.S. operations in 2012, a position he held until this January, when he left the company. At Lilly he worked on both international and federal government affairs and public policy. Other areas of focus included counterfeit medicines and health information technology.

By the way,

As part of his role at Lilly, Azar served on the board of directors for BIO, a drug lobby.

Mr Azar did have prior experience in the Department of Health and Human Services, but essentially as a lawyer/ administrator,

He served as the department’s general counsel and deputy secretary during the Bush administration.

Political, but No Medical, Health Care Professional, Public Health or Biomedical Science Credentials

To emphasize his lack of medical, health care, public health or biomedical science background, see this quote from what Mr Azar wrote this in his alumni profile for the Yale Law School,

I entered healthcare largely by accident. After law school, I clerked for Justice Antonin Scalia and then joined a D.C. law firm. I went to work for my mentor Ken Starr immediately after he became the Whitewater independent counsel.

While at my law firm, Wiley, Rein & Fielding, I was active in the Bush-Cheney campaign in 2000. After Bush won, I received a call from the office of Tommy Thompson, Secretary of the Department of Health & Human Services, asking me if I’d have interest in being General Counsel of HHS. I’ll confess that I wrestled with the question, since I had not focused on health law in my legal career.

The Politico article suggests that the Trump regime might consider most of Mr Azar’s credentials to be the top US health official are political,

He has also been a harsh critic of Obamacare and cheered GOP efforts to repeal and replace it, telling Fox Business in May that the Obamacare is ‘fundamentally broken’ and ‘circling the drain.’

Azar emerged as a strong backer of former Florida Gov. Jeb Bush’s Republican presidential campaign in 2016, serving on Bush’s 30-member Indiana steering committee in the lead-up to the election.

Azar knows Vice President Mike Pence from his time at Lilly, which is headquartered in Indianapolis.

Note that were he to become Secretary of DHHS, unless the Affordable Care Act (“Obamacare”) were to be repealed, he would be charged with enforcing it.

And years prior to that, according to the Washington Post,

Azar clerked for Supreme Court Justice Antonin Scalia and, after Bill Clinton became president, worked under special counsel Kenneth Starr as he investigated Clinton’s failed Whitewater real estate investments.

Lilly’s Poor Ethical Track Record on his Watch

Unlike the Mr Hargan, who transited the revolving door from a lobbying position, Mr Azar had direct operational responsibility, in this case, for Eli Lilly’s US operations.  Thus he ought to be held responsible for the company’s ethical misadventures during the time he was there.  In fact, the company has had a few such misadventures, some of which we have previously discussed.

Jury Found Takeda and Eli Lilly Concealed Cancer Risks of Actos, Company Subject to Punitive Damages of $36.8 Million – 2014

We discussed this in 2014.  This case seemed to involve serious deceptions, since the judge said in one ruling:

the evidence during the trial showed that the companies ‘disregarded, denied, obfuscated and concealed’ for more than a decade that Actos could increase patients’ risk for bladder cancer.

Lilly Pleaded Guilty to Charges Related to Deceptive Marketing of Zypresa as Part of an Over $1 Billion Settlement – 2009

At the time, this was considered a landmark case.  Eli Lilly pleaded guilty to a misdemeanor criminal charges and settled allegations about questionable marketing practices for its anti-psychotic drug Zyprexa for over $1 billion in 2009 (see post here).  The settlement provided some instructive information about how big pharmaceutical companies employ ghost writing to sell product (see this post). The company pushed Zyprexa for elderly patients with dementia, despite the lack of evidence that the drug’s benefits outweighed its clear harms, thus likely leading to patient harm.

Many other cases of dubious Lilly practices that did not necessarily lead to legal settlements or criminal charges can be found here.  These practices include older, lesser cases involving the revolving door; and various instances of apparently deceptive marketing practices such as planned obsolescence of drugs, use of physician “thought leaders” as covert drug marketers, payments to patient advocacy groups presumably to encourage them to act also as covert drug marketers, etc, etc

Furthermore, the company was involved in several major cases of misbehavior overseas about which  Mr Azar may or may not have been aware.  These included:

–  Lilly Fined by Brazil for “Sham” Litigation to Extend Patent on Gemzar – 2015

Per the Wall Street Journal, the government deemed the company to have engaged in anti-competitive behavior.

–  Lilly Settled Case Alleging it Bribed Foreign Officials to Win Business – 2012

We discussed this here.  This case seemed serious since it involved lavish gifts and payments made from 2006-2009 to Chinese physicians who worked for the government , bribes to health officials to Brazil starting in 2007, and other such transactions in other countries in previous years.


Last week we noted that Mr Trump famously promised to “drain the swamp” in Washington.  Last week, despite his previous pledges to not appoint lobbyists to powerful positions, he appointed a lobbyist to be acting DHHS Secretary.  This week he is apparently strongly considering Mr Alex Azar, a pharmaceutical executive to be permanent DHHS Secretary, even though the FDA, part of DHHS, has direct regulatory authority over the pharmaceutical industry, and many other DHHS policies strongly affect the pharmaceutical industry.  (By the way, Mr Azar was also in charge of one lobbying effort.)

So should Mr Azar be confirmed as Secretary of DHHS, the fox guarding the hen house appears to be a reasonable analogy.

Moreover, several serious legal cases involving bad behavior by his company, and multiple other instances of apparently unethical behavior occurred on Mr Azar’s watch at Eli Lilly.  So the fox might be not the most reputable member of the species.

So you know the drill….     The revolving door is a species of conflict of interest. Worse, some experts have suggested that the revolving door is in fact corruption.  As we noted here, the experts from the distinguished European anti-corruption group U4 wrote,

The literature makes clear that the revolving door process is a source of valuable political connections for private firms. But it generates corruption risks and has strong distortionary effects on the economy, especially when this power is concentrated within a few firms.

The ongoing parade of people transiting the revolving door from industry to the Trump administration once again suggests how the revolving door may enable certain of those with private vested interests to have excess influence, way beyond that of ordinary citizens, on how the government works, and that the country is still increasingly being run by a cozy group of insiders with ties to both government and industry. This has been termed crony capitalism. The latest cohort and now this most flagrant example of revolving door transits suggests that regulatory capture is likely to become much worse in the near future.

So, as we have said before [before, before…] The continuing egregiousness of the revolving door in health care shows how health care leadership can play mutually beneficial games, regardless of the their effects on patients’ and the public’s health.  Once again, true health care reform would cut the ties between government and corporate leaders and their cronies that have lead to government of, for and by corporate executives rather than the people at large.

Let me at least try to provide a new picture of the revolving door…

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  1. oaf

    …Friends in Canada have complaints about their medical system too…however; even with its potential shortcomings, Universal Health Care will be a great load off for most of the population in the U S of A. Perhaps it will reduce the despondency that leads to rage in our community. And the Elites may be able to cut back on their security expenditures….Win_Win!!!

    1. HotFlash

      I tell you this, socialized medicine makes ‘entrepreneurship’, whether you mean really or as an euphemism for freelancing or the gig economy, actually bearable. Nice for small business, too. We Canucks also (still) have a livable pension. w/o pension plans or your 401K’s.

      Land of the free, and home of the brave? Well, dunno about free, but you’d better be brave.

    2. sunny129

      As long as the AGENDA and the NARRATIVE controlled by powerful vested interests consistently triumphs over the interest of the general public, NOTHING will change. Neither in HEALTHCARE nor anywhere else!

      Remember per SCOTUS, a corporation is a citizen and the money is FREE SPEECH!

      How does the ‘John Q Public’ can fight the Corporatocracy in America?

      Good Luck!

  2. divadab

    Yup – and the Democrats appoint their own corrupt self-dealers when they are in power. What a filthy corrupt system – devised and run of, by, and for a traitorous ruling class.

    1. Allegorio

      Didn’t you hear former Vice President Biden state the other day on the campaign trail that the wealthy are patriots too! No Crimes against Humanity here. These are the best and the brightest, don’t you know? I just hope “former” stays in his title.

  3. David

    I’d always seen this as a feature of the US political system, not a bug. In Westminster-style political systems, only a handful of people change at the top after elections, and even in France, which has a presidential system as well, it would be unusual to parachute in complete outsiders. Thus, all but the very top jobs are held by career experts, and the very top jobs are held by politicians. This system is not without its weaknesses (and it’s been a bit undermined in the last generation), but it makes corruption much more difficult.The US system, by contrast, resembles many African ones, in that competing groups of political adventurers try to take over the state and loot it for their own enrichment. You need a new political system guys.

    1. HotFlash

      Um, here, Canada, too. Each party has a ‘shadow cabinet’, elected members of parliament who follow and specialize in the — well, it speaks for itself. They issue frequent statements, so, if you change parties due to an election, you have a pretty good idea of what the policies and the cabinet appointments will be. As David says, the core people in any ministry will be career civil servants and will actually know what they are doing, know the law, are union (gasp!) so gutting a whole ministry/department/ministry based on the party line is difficult.

      Yes, yes I know that the proceedings of Parliament are entertaining, but that is their purpose. The actual business of governing is done by career civil servants, who really do do it because they love their country, well OK, and their jobs. Chances of moving to an outrageously paid private-sector job? Slim to nil. Is there room for corruption? Yes, but not so much.

      1. nonclassical

        …reading (as all need) Michael Ruppert’s, “Crossing the Rubicon”, we find status quo is feature-not “bug”;…pp 90,91, 166,167, CIA “PROMIS” computer-A.I. system….

        …chaos is planned and orchestrated…

        (so interesting view bush-obama yesterday castigate government “civility” – stability, under trump…after what the one perpetrated, and the other refused hold accountable-allowed become status-quo…)

    2. JBird

      It’s not obvious that the federal government has been over fed and undernourished in a proxy that’s been ongoing since at least the 90s. The Congressional has been effectively cutting its own operating budget and supporting agencies or organizations such as the Office of Technological Assessment and also in the back office staff that Congress both as a whole and individually.

      Similar actions have been happening in the rest of Federal Government. I haven’t wanted to be even more depressed so I have not checked on judicial appointments or bureaucratic appointments this year. The federal government is slowly becoming a facade and not reality.

      It’s not just Trump’s incompetence.

  4. Malcolm MacLeod, MD

    I am an old and long-time retired general pediatrician for the northern California Kaiser Permanente Health
    Plan, and I feel that as regards Mr. Trump, enough is enough, and this poorly fashioned pedestrian huckster
    has proven in short time beyond belief that he is intellectually unable to handle the demands of POTUS.
    I am no fan of VP Pence, but he could not be as miserable as Mr. Trump, even if he tried. I remember a
    typing class sentence from the forties, “Now is the time for all good men to come to the aid of their country.”
    I served overseas in the “old brown shoe” Army for four and a half years, and I didn’t do it for this kind of crap.

    1. run75441


      I do not post here often as I find it counter productive. Pence is as bad as Trump except he is a politician and knows when to say it and what not to say while playing to Trump. Pence is an opportunistic zealot who knows and calculates what he is doing as compared to Trump.

      As an X-Marine Sergeant, the opportunity to serve my country did not include whether I agreed or did not agree with its politics. There was no choice of agreement and as X-military you should know this too. Good to see you out here sir.

  5. Frank Howell

    What is the FDA’s role in these matters? Do they have any regulatory authority to mitigate bad medicine?
    Did they approve the drugs Actos and Zyprexa? What good are they with results such as this?

  6. Allegorio

    What is needed in this country is a national health service, one that conducts research on what is effective and what is not. One that takes steps for public health and to prevent epidemics. One that runs non profit hospitals and provides services to all for free. Demonetize medicine.

    Medicare for all is not the solution. The corruption generated by Medicare is enormous. The NIH does all the research anyway and then gives away the patents to the “cronies”. Take the money out of politics and take the money out of medicine. Medicine is a public service and not a profit center for corrupt psychopaths.

    1. Ian

      Medicine is ideally a public service, but as it stands in much of the world with the US as sadly an excellent example and it’s lead zeolot for said institutions, it very much is a profit center for corrupt psychopathic institutions. I dearly wish this was not the reality.

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