Trump is flooding the swamp with his HHS pick, Alex Azar

On Monday, despite numerous promises to “drain the swamp,” Trump chose a seasoned drug executive, Alex Azar to be his next nominee for the United States Secretary of Health and Human Services. Like a beaming host of a reality TV show, he tweeted that Azar “will be a star for better healthcare and lower drug prices!”

At least Trump is consistent. Almost his entire cabinet is now stacked with industry executives with major conflicts of interest.

{mosads}For example, Treasury Secretary Steve Mnuchin worked for Goldman Sachs for 17 years before becoming a hedge fund manager. Not surprisingly, Mnuchin is a strong advocate for lowering corporate taxes.

Rex Tillerson was the CEO of Exxonmobil before becoming Secretary of State. At Exxon, he made numerous business deals with Vladimir Putin and opposed sanctions with Russia. Wilbur Ross, a banker formerly known as the “king of bankruptcy,” is now our secretary of Commerce. The list goes on.

As for Azar, his whole resume speaks volumes about the intimate relationship between the federal government and major corporations. He is a lawyer by trade and son of a retired ophthalmologist, who despite having no prior health care experience, became Deputy Secretary of Health and Human Services under President George W. Bush.

He even stated on his Yale Law School alumni biography page that he “entered healthcare largely by accident” and that he “wrestled with the question” of doing his job at HHS because he “had not focused on health law in [his] legal career.”

After his time at HHS, where he apparently honed his healthcare skills, he immediately worked for Eli Lilly and Company, the corporation he had been tasked to regulate. He then rose to become head of its US operations, during which time he more than doubled the price of Lilly’s major insulin product, Humalog. In fact, on Jan. 1, 2012, when Azar officially became President of Eli Lilly U.S., the price of Humalog was $123 per vial. When he left in 2017, it was $255.

As a surgery resident, especially one who has performed amputations in diabetic patients with gangrenous feet and legs, and who watched people die in the intensive care unit from complications of diabetic ketoacidosis, I must disclose that doubling the price of insulin personally outrages me. Physicians have an incredibly tough time making sure that patients keep their blood sugars under control when they leave the hospital, especially if they cannot afford the price of the drug.

That being said, in many ways Azar’s actions are even more morally repugnant that those of Martin Shkreli, who raised the price of anti-parasite drug Daraprim by 5000 percent. Whereas 2,000 Americans depend on Daraprim for treatment of toxoplasmosis, over 29.1 million Americans have diabetes, many of whom require insulin. Although under the radar, Azar’s actions are vastly more harmful and incredibly more profitable.

Azar has previously gone on record stating that the government should not intervene in the pricing of drugs and that insurers and pharmaceutical companies should work together to lower them voluntarily. It would at best be naïve to think that for-profit companies, out of pure altruism, would lower drug prices to help sick and dying patients. But Azar literally rose the price of insulin, one of the most essential drugs in all of healthcare, while he was the head of a pharmaceutical company working out deals with insurers.

Unlike orthopedic surgeon Tom Price, the bumbling former HHS secretary grounded by a private jet scandal, Azar is a career lobbyist and bureaucrat who despite having no healthcare experience or interactions with patients knows how to get things done politically. Nobody is disputing his experience and qualifications, and he has every right to be confirmed as Judge Merrick Garland did under Obama.

But as someone who opposes the Affordable Care Act, supported Republican repeal measures, and raised the price of critical lifesaving drugs as a pharmaceutical executive, Azar is the one Secretary of Health and Human Services who will go down in history as most effectively annihilating health and human services. Score this one as a win for the pharmaceutical and insurance industries and a devastating loss for the American people.

A lion may have a fearsome roar but it’s the tiny mosquito, one that insidiously spreads disease among the weak and vulnerable, that kills the most humans every year. Azar is that mosquito, bred in the swamp of Washington D.C., flying under the radar quietly and undetected, while he raises the price of insulin and strips us of our healthcare and our lives.

Dr. Eugene Gu is a resident physician at the Vanderbilt University Medical Center and president of the Ganogen Research Institute. He graduated from Stanford University with honors and holds an M.D. from the Duke University School of Medicine.