By Marika Sboros

Is Big Pharma really as sinister as research suggests? Certainly, its products have been life-saving but also life-taking. And the world’s biggest pharmaceutical companies have long had unhealthy effects on economies in many countries. Consequently, people’s health in those countries has become secondary to Big Pharma’s profits.

It is especially the case in the US, which spends the most per capita on prescription drugs than any other country. Research by The Law Firm shows that Americans filled 4.3 billion prescriptions for $374 billion dollars in 2014.

Rebecca Hill has developed an innovative infographic for the personal injury law firm on how Big Pharma spends its money. (Scroll down  to view it below).  It highlights the effect of the spend on the health and finances of Americans, says Hill. It also reveals who spent the most money – Genentech, which spent $388 million in payments to 1,888 doctors. And it points the way forward to reducing the burden of Big Pharma on people’s health and pockets, she says.

That way requires re-educating doctors to overcome their reliance on drugs as first resort. Hill is a blogger and outreach co-ordinator, a graduate of  York University, in Ontario, Canada, who loves all thing tech and science. In the graphic, she refers to a  groundbreaking 2011 study in the JAMA (Journal of the American Medical Association) . Lead author of the study, titled Principles of Conservation, is Harvard Medical School internal medicine specialist Dr Gordon Schiff. Schiff is also associate professor of medicine at Harvard.

Rebecca Hill

The study authors say that drugs are the therapy physicians most frequently deploy. They need to learn to “think beyond drugs”.

“It is often impossible for patients and physicians alike to imagine ending a clinical encounter without a medication prescription,” they say. Likewise,  for most doctors, “it is equally unimaginable not to turn to the most up-to-date drugs” to help patients.

They prescribe “conservative prescribing”. They say that it’s an approach that goes beyond the oft-repeated physician’s mantra of “first, do no harm.” It sums up lessons from past experience and research demonstrating that doctors commonly use medications inappropriately and excessively.

Conservative prescribing also embodies a new construct, which they call the precautionary principle. It’s an ecologic paradigm that stresses forecaring. In other words, doctors learn to anticipate potential adverse effects even when science hasn’t fully established cause-effect relationships.

Rather than mainly prescribing drugs, doctors should broaden their repertoire to include effective counseling, the authors say. Doctors should also learn to prescribe exercise, physical therapy, diet changes, smoking cessation, orthotics, or surgery when appropriate. Substantial literature supports non-drug measures as initial or preferred therapy for a range of conditions that doctors commonly treat with drugs. Among these conditions are hypertension, diabetes, insomnia, back pain, arthritis, and headache.

The study authors say that mastering conservative prescribing is “especially important for young physicians and trainees”. That’s because they “lack historical knowledge of past drug harms and withdrawals from the market”.




Learning to prescribe is a skill, the authors say, just like learning to perform a procedure or becoming facile in physical examination. Medical schools relegate this important skill to a few pharmacology lectures on pharmacokinetics or dosing.

Other tips for doctors include to:

  • Start treatment with only one drug at a time, whenever possible;
  • Have a “high index of suspicion” for adverse drug effects (ADEs);
  • Educate patients about ADEs so they recognise these as early as possible; and
  • Learn about new drugs and indications from trustworthy, unbiased sources

Patients also have a responsibility. Hill says that staying informed helps people to make the best decision for their health. It also helps to prevent Big Pharma from “using their money and influence over trusted healthcare professionals”.



  1. The GPs’ committee of the British Medical Association voted unanimously against the wider use of statins. The committee that made the final decision ignored doctors and approved the wider use of statins. Eight of the committee who voted for extra prescribing had acknowledged links to pharma.

    How can the public have any confidence in their health systems?

    • Quite!

      To be fair, there has been a major and very successful improvement in treatment of acute conditions, via drugs and improved surgical techniques.

      Chronic disease, not so much. Yet that’s where all the profit lies and where all the research is concentrated – principally in producing antidotes to a toxic but profitable diet. Keep people ill, but not dead yet. I will place money on the fact that the research budget for “diabetes drugs” far outweighs the budget for new and improved antibiotics by several orders of magnitude.

      • Exactly, Chris. I wonder about this long term model of this. If they continue making people ill, how will Governments be able to pay for all these drugs? Long term, of course, is beyond the current Chief Exec’s thinking.

        I’ve heard a drug company executive recently saying, ever so politely, that the payment model for antibiotics would have to change before they’d invest in them. As you say, the goose that lays the best is the long term condition that requires drugs for life. Statins and diabetes drugs are a dream for pharma. What would they do if all diabetics cured themselves with a low carb diet? I suppose they’d invent another illness and spend millions worrying people about it. They spend twice as much promoting a drug than on its research. They don’t talk about that very much.

        • Why do you think so much effort is being put into privatising the NHS? By making it impossible for it to continue to function the Government (either party) is lining it up for sale to the highest bidder – Richard Branson and mostly the American insurance companies/HMOs. Ever seen the hoops the Yanks have to jump through to obtain healthcare – and the amount they have to pay? Coming shortly to a country near you. . .

Leave a Reply

Your email address will not be published.


This site uses Akismet to reduce spam. Learn how your comment data is processed.