Thursday, March 23, 2006

The roots of health fraud

I'm just back from another "road" trip, although this one included a bumpy ride via a Southwestern bird (I thanked the pilot for landing us), and several interesting conversations in taxicabs. I was meeting with some folks to talk about health fraud, which you know is a concern here at Texas AIDS Network. While the ostensible purpose of the meeting was to plan a conference for FDA-sponsored health fraud task forces to be held later in the year, a recurring issue in the general discussion related to the roots of health fraud, or, more specifically, why does America provide such fertile soil for health fraud?

The discussion took two not entirely opposing points of view: that there is something in human nature that allows openness to fraudulent products more or less versus the viewpoint that there are social and cultural factors that provide for that openness. No doubt these viewpoints and the issues that they reflect will be addressed more fulsomely at the conference.

In the meantime, here are some thoughts that arise from that maddenly brief discussion of the roots of health fraud.

  1. Barriers to health care become an open door for health fraud. When people are denied access to health care or that access is difficult, the need to deal with their health problems still remains. They will look for alternatives to which they can have easy or affordable access, and many of these alternatives may be fraudulent. We have discussed barriers to care elsewhere. These same barriers provide, I think, social and cultural factors that promote health fraud.
  2. Social demography promotes, or at least predicts, health fraud. As we look at those who are most often the victims of fraud, no matter whether it is health fraud or some other kind of scam, the pattern seems to show that some demographic groups have some predictable vulnerabilities to fraud. Age, for example, may predict vulnerability to health fraud. The elderly are usually retired, available during business hours to telemarketers who may target them for various scams. The elderly may often be isolated from social contacts and look to scam promoters as a source for social relationships, making them vulnerable to exploitation. Similarly, the young, for very different reasons, have vulnerabilities because of their lack of experience and knowledge and their special susceptibility to peer pressure.
  3. Beliefs and belief systems promote health fraud. Where disease comes from is defined by our belief system, which may tell us that bacteria and viruses are culprits. Our belief system may just as easily attribute disease to supernatural causes ("evil spirits," "God's will," "broken tabus"). Similarly, specific cultural beliefs that value such things as antiquity may lead us to think that something that is "ancient" has special significance or value. Such beliefs open the door to snake oil and quackery.

This is a matter that intrigues me. Its importance for the Texas HIV/AIDS community lies in the fact that AIDS health fraud is big business everywhere, including Texas. We have several ethnic communities with vulnerabilities to health fraud because of their belief systems. We have several small businesspersons actively promoting products that are harmful to persons with HIV/AIDS. We clearly have numerous barriers to health care, including access to HIV/AIDS medications, in Texas. No doubt you'll be reading more on the subject in the days ahead.

No comments: