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Using the pharmaceutical sector as a microcosm of the health sector, we highlight the most prevalent structural and policy issues that make this sector susceptible to corruption and ways in which these vulnerabilities can be addressed. We conducted a literature review of publications from 2004 to 2015 that included books, peer-reviewed literature, as well as gray literature such as working papers, reports published by international organizations and donor agencies, and newspaper articles discussing this topic. We found that vulnerabilities to corruption in the pharmaceutical sector occur due to a lack of good governance, accountability, transparency, and proper oversight in each of the decision points of the pharmaceutical supply chain. What works best to limit corruption is context specific and linked to the complexity of the sector. At a global level, tackling corruption involves hard and soft international laws and the creation of international standards and guidelines for national governments and the pharmaceutical industry. At a national level, including civil society in decision-making and monitoring is also often cited as a positive mechanism against corruption. Anticorruption measures tend to be specific to the particular “site” of the pharmaceutical system and include improving institutional checks and balances like stronger and better implemented regulations and better oversight and protection for “whistle blowers,” financial incentives to refrain from engaging in corrupt behavior, and increasing the use of technology in processes to minimize human discretion. This chapter was adapted from a discussion piece published by Transparency International UK entitled Corruption in the Pharmaceutical Sector: Diagnosing the Challenges.

Nutrition, as a science, is poorly understood, both professionally and publicly. The confusion that surrounds this science makes it very difficult, if not impossible, to formulate public health policy, which creates opportunities for political manipulation and control. Nutrition, for a century or more, has been variously described as a summation of the physiological and biochemical properties of individual nutrients in food rather than the whole food itself. This infers that isolated nutrients in supplements will function in the same way as nutrients in food. It also infers that removing or minimizing “undesirable” nutrients from food will make the food more healthful. This arises from the highly reductionist way that we focus on individual nutrients minus their natural context, both the context within the foods of which they are a part and the context within biological systems where they function. The shortcomings of this belief system may be illustrated by hugely costly mistakes made in the past, even more than a century ago, that corrupt current practices. Such mistakes have become so embedded in the contemporary narrative on nutritional science, both fundamentally and practically, that we fail to recognize the damage they continue to cause.

Alternatively, when nutritional effects are considered more within their natural contexts, that is, more wholistically, then it helps to explain, for example, the remarkable ability of nutrition, as provided by a whole food plant-based diet, to prevent even to cure varied types of cardiovascular disease. Furthermore, the breadth of this nutritional effect for a wide variety of illnesses and diseases suggests that nutrition, properly provided by a whole food plant-based diet, is more efficacious than a combination of all the contemporary pills and procedures combined. It also suggests that genetic determinism is not the explanation for disease that is widely advanced. And finally, among still more consequences, there are many societal outcomes that can be substantially mitigated, including the escalating cost of health care and the dangerously increasing array of destructive practices that damage the environment. Many of the momentous health, economic, environmental and sociopolitical problems currently faced may be traced to a misunderstanding of the effects of food and nutrition. The task therefore is how to bring this message to the attention of a public who for too long have gradually adopted flawed food production and healthcare systems that are on the verge of collapse, threatening the collapse of entire societies as we know them. More specifically, a public and professional dialog on the meaning of nutrition, especially its wholistic properties, is desperately needed, especially in medical schools where nutrition as a science is almost totally ignored.