Conflicts of Interest in the Trump Administration: The Cases of Alex Azar and Brenda Fitzgerald
Alex Azar, secretary of Health and Human Services. Photo: Wikimedia 
It is slim relief that Brenda Fitzgerald was forced to resign last week as director of the Centers for Disease Control and Prevention. Her final offense in her very short and immoral tenure was investing in tobacco stocks after being appointed in July, according to a Politico report. Before being appointed by the Trump administration, the former Georgia health commissioner had long invested in cigarette companies whose products kill 480,000 Americans a year and 6 million worldwide, according to her own agency.
She was further compromised by investments in drug, insurance, and health diagnostic firms that posed conflicts in dealing with cancer, opioids, and dissemination of health information. She told the New York Times that she was considering renewing CDC ties with Coca-Cola. In Georgia, she was a cheerleader for Coca-Cola’s physical fitness programs. The world’s largest soda company, based in Atlanta, was exposed in 2015 for funding scientists who said America’s obesity crisis was all about exercise, not the excess empty calories from sugary drinks. As documented by the Union of Concerned Scientists, Coca-Cola was following an all-too-common tactic of the corporate disinformation playbook—hiring scientists to produce results that obscure a product’s harm.
But her departure hardly guarantees that we can count on the CDC to protect the nation’s health. For the moment, the acting director is Anne Schuchat, a respected infectious disease expert, known for leading domestic and global response teams against flu viruses in the US and infectious diseases in Africa and China, including Ebola and SARS. A member of the National Academy of Medicine and a rear admiral in the United States Public Health Service, her disease detective work was the model for a lead character Kate Winslet played in the movie “Contagion.”
The ethical conundrum of Alex Azar
It is rare for acting directors, even if immortalized by actresses, to win a full appointment. So who comes next bears serious watching, especially since Alex Azar is the new secretary of Health and Human Services (HHS), the department that oversees the CDC, and he himself is an ethical conundrum.
Azar, a lawyer who clerked for the late conservative Supreme Court Justice Antonin Scalia, and was on George W. Bush’s legal team for the 2000 Florida recount, became general counsel at HHS and ultimately deputy secretary of the department. He left in 2007 to become the top lobbyist for the Eli Lilly pharmaceutical giant and worked his way to the presidency of the company in 2012.
When President Trump nominated him in November to replace Tom Price, who abused taxpayer dollars by traveling by private jet, the president tweeted Azar “will be a star for better healthcare and lower drug prices.” When Azar was sworn in on January 29, Trump, who has repeatedly said that drug companies get away with “murder,” said prices would now “come rocketing down.”
From drug company CEO to people’s champion on drug prices? Unlikely.
There is no evidence to remotely suggest that Azar, the first pharmaceutical executive ever to head HHS, according to the Washington Post, will miraculously transform from drug company CEO into the people’s champion on drug prices. In July, the Indianapolis Business Journal reported that in the last 20 years, while the price of milk went up 23 percent, the cost of a Dodge minivan rose 21 percent and general inflation was 32 percent, the price of Lilly’s insulin drugs Humalog and Humulin skyrocketed by 1,157 percent and nearly 800 percent respectively. A vial of Humalog that cost $21 in 1996 cost $274.70 last summer.
Lilly is a defendant along with global diabetes drug titans Novo Nordisk and Sanofi in a class action price-fixing lawsuit filed last year in federal court in Massachusetts. According to the lawsuit, Lilly’s Humulin shot up 325 percent from just 2010 to 2015, a period covering Azar’s first three years at the helm. Several news stories and guest columns last year featured the difficulty many American diabetics have in affording insulin. One out of every eight American adults has diabetes, and the lower the socioeconomic status, the higher the incidence of the disease.
According to the CDC, diabetes was listed as any cause of death on a quarter million US death certificates in 2015, and the annual direct and indirect cost of diabetes to the nation is a quarter billion dollars. Several small studies over the last two decades have shown that high percentages of patients admitted to hospitals with life threatening diabetic ketoacidosis became sick after discontinuing insulin therapy because it was unaffordable.
Lilly blamed the rise in drug prices to other parts of the health care system, but it refused to disclose to the Indianapolis Business Journal its net prices. Lilly ranks 132nd in the Fortune 500 with profits last year of $2.7 billion.
Keeping a watchful eye
Pressed in his Senate confirmation hearings on drug pricing, Azar acknowledged they were high but offered no major solutions, having opposed the Affordable Care Act and saying the government should not have a heavy hand in negotiating drug prices. As average Americans struggle with diabetes drug costs, Azar made $3.6 million in his last year at Lilly in salary and severance. He also sold off $3.4 million in Lilly stock, according to the Associated Press.
Azar’s light hand on out-of control drug prices merits a very watchful eye over both HHS and CDC. We need to make sure that our government officials, especially those making decisions about access to health care, advocacy against diseases, and scientific research aren’t beholden to profitable companies producing drugs, cigarettes, soda, or other health-related products or services. Before her departure, Fitzgerald came under fire when the Washington Post reported that certain words were being banned from budget requests, such as “evidence based” and “diversity.”
Trump says that under Azar, drug prices will come rocketing down. In actuality, the watch is on to see if Azar instead is another incoming missile from Trump against federal protection of the nation’s health.
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