Profits have crept into the exam room. Prescriptions, referrals, and even the time a doctor spends with a child in pain can be tilted by money quietly changing hands behind closed doors. Professor Mishal Khan has spent her career pulling back that curtain, tracing how the commercialization of healthcare bends decisions away from patients and toward corporate gain, especially in countries where people can least afford it.
Her research shows that when pharmaceutical companies, private hospitals, and donors dominate the rules of the game, vulnerable patients pay twice: once at the pharmacy counter, and again in poorer health. Her message to governments and global health leaders is blunt: conflicts of interest in medicine are no longer a side issue; they are a public health emergency.
How Money Warps Care: From Hidden Bribes To Skewed Prescriptions
In Pakistan and across Asia, Khan has documented how informal payments and industry influence the way care is quietly steered. One of her most widely discussed studies exposed how doctors received bribes to favour certain medicines and services, using a novel method to capture “hidden” behaviours that rarely appear in official records. Rather than relying on self-reporting, her team built tools that made it safer for people to speak about corrupt practices, revealing just how routine these incentives had become.
Healthcare in low- and middle-income countries is often fragmented, underfunded, and increasingly dominated by private players. Under such conditions, commercial incentives slip into every gap. Doctors can be pushed to prescribe more expensive drugs when cheaper, effective generics exist. Private clinics may order unnecessary tests or refer patients into costly specialist chains because every step generates fee income.
Khan’s work in The Lancet and BMJ Global Health has tracked how these dynamics especially hurt the poorest families, who frequently borrow money, sell assets, or stop treatment early because they simply cannot keep up with spiralling costs. Her analysis connects individual choices in clinics to broader systems of power, mapping how pharmaceutical marketing budgets, weak regulation, and political patronage influence clinical decisions.
Her long-standing focus on governance failures – such as corruption, weak oversight, and opaque procurement – shows that conflicts of interest rarely appear as isolated “bad apple” cases. Instead, they sit inside networks: industry representatives courting doctors, local politicians lobbying for private hospital owners, donors preferring eye-catching programs over steady investment in public clinics. Once those interests align, patients’ needs become negotiable.
Khan often stresses that the new glamour of “global health” can hide old injustices. Aid cuts from major donors squeeze public budgets, while private companies gain room to market themselves as problem-solvers. When those companies help write national guidelines, sponsor conferences, or support research, conflicts of interest spread throughout the system rather than remaining at the bedside.
Power, Bravery, And The Politics Of Saying What Others Whisper
Khan’s work does more than log abuses; it challenges who gets to shape the rules of global health. Coming from an underrepresented background, she pushed through social barriers to win a double first at Cambridge and became a full professor at the London School of Hygiene & Tropical Medicine before turning forty. That rise gives weight to her critiques of the institutions that now invite her to speak.
Her research has laid bare how ethnic minority women in academia struggle to reach senior positions, and she helped oversee an independent review of racism at her own institution. That same readiness to confront uncomfortable truths shapes her stance on conflicts of interest: the people who profit most from commercialised care usually sit in boardrooms far from the clinics whose budgets they squeeze.
Her work on decolonization and racial equity in global health is linked directly to conflicts of interest. When decision-making power resides in London, Geneva, or Washington, while patients are in Karachi, Phnom Penh, or rural Indonesia, commercial and geopolitical interests can overshadow local priorities. Khan argues that lower-income countries must regain control over setting their own health agendas, or they will remain vulnerable to corporate and donor pressures that treat their populations as markets rather than citizens.
Underneath the technical language of “health systems strengthening,” her projects carry a clear moral charge. Bribery in hospitals is not just about wasted money; it is about a mother who walks away from a clinic because she realizes safe care is reserved for those who can pay under the table. Pharmaceutical marketing is not just about brand loyalty; it is about children receiving antibiotics they do not need while lifesaving drugs remain out of reach elsewhere.
Khan’s long-term goal is to be widely known and trusted enough to speak directly to ministers, donors, and multilateral agencies about these dynamics. Her academic record – from early publication of a randomised trial in The Lancet at 24 to recent studies on corruption and conflicts of interest – underpins that ambition with evidence. Her public voice, sharpened by years of challenging unjust hierarchies, gives those findings political bite.
Bold Policy Reforms To Protect Patients From Commercial Capture
Changing this system demands more than polite guidance; it requires rules strong enough to break the grip of commercial interests over health decisions. Khan’s work points toward several urgent reforms.
Governments need strict, transparent controls on the relationships between healthcare professionals and industry. Public registers of financial ties, bans or hard limits on gifts and sponsored travel, cooling-off periods for regulators taking industry jobs, and independent oversight bodies can reduce the quiet flow of influence that now seeps into everyday practice. Without such guardrails, any clinical guideline or drug list can be quietly tilted by those who stand to gain.
Health financing reforms must curb the incentives that reward over-treatment and expensive brands. Moving away from fee-for-service models toward payment systems that reward quality and appropriate care can cut the drive to oversell drugs and tests. At the same time, strong public procurement systems can leverage bulk purchasing to secure affordable, high-quality generics, while publishing contract details to deter kickbacks and collusion.
Khan’s focus on vulnerable populations emphasises the need for legal and civic muscle. Whistleblower protections, accessible complaint mechanisms, and civil society watchdog groups can empower patients and frontline workers to speak out against abusive practices. When a nurse witnesses a colleague accepting secret payments, or when a family is pressured into unnecessary and costly procedures, they need safe channels to speak without fear of retaliation.
Global funders and donors cannot remain exempt from scrutiny. Conditions attached to aid should reflect accountability in both directions: recipient governments are expected to guard against misuse, while donors must avoid pushing projects that serve corporate interests or short-term political agendas. Funding models that give low- and middle-income countries genuine decision-making power, rather than tying budgets to preferred suppliers or high-profile vertical programs, are central to the reforms Khan argues for in her broader work on health governance.
Education for future health professionals forms the final pillar. Medical and public health training should expose students to the realities of commercial pressure, conflicts of interest, and structural inequities early on. When young doctors and policymakers learn to recognise how money can sway data, guidelines, and clinical choices, they are better equipped to resist it.
Khan’s career demonstrates that speaking candidly about power and profit in medicine carries risks, particularly for women and scholars of color. Yet it is precisely that readiness to confront entrenched interests that has made her a leading and trusted voice in debates over health systems, corruption, and commercialisation.
Her research warns that unchecked conflicts of interest will deepen inequality, corrode trust, and weaken the very systems people rely on when they fall ill. Protecting vulnerable populations means taking her warning seriously: healthcare cannot keep serving two masters – profit and patients – without betraying those who have the least.
