I Will Build a Great Swamp, and Nobody Builds Swamps Better than Me

By Sergio Sismondo

Individual corruption is when government officials take bribes or use their positions for personal enrichment. Little can be more incendiary, can more reliably anger voters and taxpayers, than charges of this kind. That’s why “Crooked Hillary” was such a powerful phrase during the 2016 election— however well or poorly founded the accusation. With characters like “Crooked Hillary” in mind, Trump promised to “drain the swamp.”

Corruption still carries some of its slightly archaic stench of rottenness, infection and decay, moreso when the whole body of an institution becomes infected or is decaying. When old-fashioned corruption extends beyond isolated cases, or when it structures government actions from the top, a swamp emerges that takes on a different character. The creatures living in it look less dangerous than the swamp itself, with its (to borrow from Milton) “Vapour, and mist, and exhalation hot; Corrupt and pestilent!”

Lawrence Lessig defines “institutional corruption” as systemic influence that undermines an institution’s effectiveness at serving its purpose. Coming from STS, I’m suspicious of talk of an institution’s “purpose,” but we should still expect public institutions to serve broad public interests.

Sometimes public institutions develop a kind of sclerotic corruption, when they preserve themselves at the expense of serving other interests. They become bureaucratic, rigid and unresponsive, responding more to internal pressures and imperatives than anything else.

But institutional corruption takes more powerful and dangerous forms. In my research, I explore how pharmaceutical companies systematically control or influence the production, distribution and consumption of medical knowledge. These companies design, fund and analyze significant amounts of the research on their products. They use that research to construct and publish articles in medical journals—typically “authored” by apparently independent medical researchers who have had minimal inputs into the research, analysis and writing. The companies then hire “key opinion leaders” to promote that work at conferences and in talks to clusters of doctors. The companies sponsor continuing medical education based on their research. Medicine is corrupted, but not because of individual misconduct or sclerosis. The entire corpus of medical knowledge is bent to further the interests of a small number of powerful actors. This is corruption by capture.

Corruption still carries some of its slightly archaic stench of rottenness, infection and decay, moreso when the whole body of an institution becomes infected or is decaying

The Trump administration has almost guaranteed this third kind of corruption by systematically putting the regulated in charge of regulations: We now have regulatory capture on speed.

The new Treasury Secretary, Steve Mnuchin, worked for 17 years on Wall Street at Goldman Sachs and owns his own bank. Five other cabinet members or Trump advisors have worked at Goldman Sachs. One of Trump’s early statements as President was a promise to roll back Dodd-Frank legislation, much of which serves to constrain the banking industry in the name of protecting consumers and stabilizing the financial system.

Various important players in the energy industry are now key advisors. Secretary of State Rex Tillerson came to Washington directly from his position as CEO of Exxon. Meanwhile, Scott Pruitt is now the administrator of the Environmental Protection Agency. Prior to this, Pruitt was attorney general of Oklahoma, where he repeatedly took parts in lawsuits against the EPA. Released emails show that some of his actions against regulation were scripted word-for-word by energy companies, which also donated generously to political organizations that supported Pruitt’s re-election campaigns. In one case, an energy company wrote a letter for Pruitt, taking care to place it on Oklahoma State stationary.

The healthcare industry also is well represented among Trump advisors. Although President Trump campaigned on a promise to demand price concessions from the pharmaceutical industry, he quickly signaled that his main move with respect to Pharma would be to reduce regulation. The new Health and Human Services Secretary, Tom Price (who as a Congressman appeared to violate Congressional ethics rules with his advantageous stock trades in the health industry), is opposed to negotiating with Pharma for lower prices. Rumored FDA Commissioner Jim O’Neill has spoken in favor of the FDA regulating only drug safety, not drug efficacy.

Large companies and industry actors are the ones able to most thoroughly bend the bodies of government departments and agencies around their needs, to corrupt by capture. Trump’s campaign attacks on Wall Street influence already recognized that narrow corporate interests don’t line up with broad public interests. Yet it has systematically put industry representatives in charge of the organizations that regulate those industries. Many are in direct conflict with the departments and agencies they run.

Some small wetlands of individual and sclerotic corruption may well be drained over the coming years, but to make space for much larger and more pestilential swamps.

Sergio Sismondo is a professor at Queen’s University, Canada.