Miriam and Sheldon Adelson have donated millions of dollars to political action committees this election season. Credit: N. Kamm/AFP/Getty Images

A slow economy has not stopped the biomedical industry from spending big on US elections this year. According to the Center for Responsive Politics, a non-partisan group that analyzes political spending, the health sector — which includes the pharmaceutical and biotechnology industries, health insurance providers, hospitals and organizations representing heath care professionals — has so far poured more than US$193 million into campaign coffers and political action committees (PACs) in hopes of influencing the 6 November vote.

The record breaking figure is roughly 9% greater than the amount spent by the health sector during the 2008 election that swept US President Barack Obama into the White House. Overall, the sector ranks fifth in spending out of thirteen industry sectors that are monitored by the Washington DC based center.

This year, as in 2008, the health sector contributed more money to Obama, who heads the Democratic ticket, than to his Republican rival, Mitt Romney. But when spending on congressional races is also considered, Republicans have received about 56% of all health sector contributions for this election cycle, in keeping with long-term trends.

Topping the list of the sector's big donors is the Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse Treatment and Research in Las Vegas, Nevada. Miriam Adelson, is a physician and wife of billionaire Sheldon Adelson, chief executive of the Las Vegas Sands Corporation. The clinic has given $20 million to promote political causes during the current election cycle, with half of it going towards Restore our Future, an independent conservative political action committee known as a ‘super PAC’, that endorses Romney.

SuperPAC contributions, made possible by a 2010 US Supreme Court decision and related rulings, allow unlimited spending by individuals and businesses who support or oppose candidates, as long as they do not give directly to candidates' campaigns. About $38 million of the money spent by the health sector for 2012 elections was given over to SuperPACs and other 'outside' groups, who in turn spend the money on political advertisements. In 2008, prior to the legal rulings, the health industry sent just $96,80 to outside groups.

“Contributions are support for people who are receptive to the things you care about,” says Peter Kezirian, senior vice-president for corporate strategy and product development at the Cooperative of American Physicians in Los Angeles, California. The group, which seeks to influence malpractice liability reform, has spent about $2.1 million this election cycle, most of it in the form of 'outside' contributions such as those to SuperPACs. “You have to make sure your point of view is represented,” Kezirian says.

Other top health sector donors include the drug company Pfizer (based in New York) and the American Academy of Orthopaedic Surgeons (based in Rosemont, Illinois), both of which spent about $1.5 million, and the American College of Radiology (based in Reston, Virginia), which spent $1.4 million.

Amgen, a biotechnology company based in Thousand Oaks, California, gave $1.2 million, split about evenly between direct contributions to candidates in both political parties. The company says in choosing who to donate to it considers candidates' views on issues important to the company and if Amgen has a facility in the candidate's district. According to lobbying records analyzed by the Center for Responsive Politics, Amgen had official meetings with legislators concerning Medicare reimbursement, the new federal health reform law and drug-safety legislation

Companies based outside of the United States are technically not allowed to donate to US elections. But companies are permitted to do so if they have US subsidiaries. For example, the British-Swiss drug company AstraZeneca, headquartered in London, gave $941,000 to candidates this election cycle. US rules also prohibit foreign companies from directing or influencing the PACs of its US subsidiaries but in practice, little stands in the way of this happening, critics say.

Although the involvement of health-related organizations and drug manufacturers in the US electoral process is not particularly new, it raises ethical questions, says Judy Nadler, an expert in government ethics at Santa Clara University in California. “We have an inherent trust in health-care providers, but we have to understand that they are part of a larger system,” Nadler says. “Unless you tracked the lobbying efforts of some of these entities, you would have no idea what is happening behind the scenes and changing the way [medicine] is practiced.”