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(Health Secretary, RFK Jnr: Our medical system is riddled with perverse incentives, hospitals, pharmaceutical companies, and insurance companies profit by keeping Americans sick)
Dr Pierre Kory told the United States Senate that the medical establishment has waged a systematic war against safe, repurposed medicines. He pointed to the 32,000 approved drugs already in the National Library of Medicine and asked why proven treatments inside that catalogue are ignored while only expensive new patents advance and his answer was the profit motive. New drugs deliver margins that cheap, off-patent molecules cannot, and so incentives tilt not just toward new patents but against generics that threaten to compete. He described how regulators and journals allowed disinformation campaigns to discredit low-cost medicines, designing trials to fail through under-dosing, delayed treatment, or narrow enrolment. Selective publication then sealed the verdict. Positive trials vanished as the negative ones were amplified, creating an illusion of ineffectiveness, and mind you, these are not fringe claims. Marcia Angell, former editor of the New England Journal of Medicine, warned in 2009 that it had become impossible to believe much published clinical research. The pandemic laid the problem bare when cheap drugs showing signals of benefit across hundreds of trials were smeared as quackery, while only medicines costing hundreds or thousands of dollars made it into guidelines. Evidence was just buried because it threatened a billion-dollar narrative, nothing to do with any proof of weakness.
American healthcare costs keep rising while outcomes trail peer nations, and people paying the premiums know the structure is broken. Employer health insurance for a typical family reached $23,968 in 2023 and $25,572 in 2024, with workers still paying thousands out of pocket on top of taxes and lost wages; those numbers reflect a system designed to extract, and has nothing with economising let alone healing.
(U.S. healthcare spending is exploding, projected to hit around $5.3 trillion in 2025 alone, growing at 5.6% from the previous year)
Regulation that should restrain excess has been wired to depend on those it regulates. In fiscal year 2022, user fees paid by industry made up 46 percent of the Food and Drug Administration’s total budget, and two thirds of the human drugs programme specifically; the agency’s own materials and federal briefings confirm rising reliance on fees negotiated with manufacturers. That arrangement builds structural dependence into the review process and blurs lines between public duty and private interest.
Editors and senior physicians have been warning about captured science for years, and their words deserve full weight. Marcia Angell, former editor in chief of the New England Journal of Medicine, wrote in 2009 that believing much of the clinical research had become untenable, after watching financial ties twist questions, methods, and messages across the field. Richard Smith, former editor of The BMJ, described medical journals as extensions of pharmaceutical marketing, after repeated encounters with ghostwriting, selective publication, and suppression of inconvenient results. Richard Horton, editor of The Lancet, reflected in 2015 that large chunks of the literature may be untrue, given bias, conflicts, and poor methods. These are establishment voices describing an establishment failure.
Evidence of distortion appears whenever full data finally reach daylight. Antidepressant trials submitted to the FDA looked positive in journals, but when all studies were compared with agency records, negative results had often gone unpublished or were written to appear positive; selective reporting skewed the apparent efficacy for patients and prescribers. Registered trial outcomes have also shifted between protocols and publications, with favourable endpoints appearing while original primary endpoints fade, a pattern documented by methodologists two decades ago and still relevant today. Those are not small irregularities; those practices set the evidence base that drives guidelines, prescribing, and reimbursement.
The Tamiflu story shows how opacity magnifies waste. Governments spent billions stockpiling oseltamivir based on manufacturer-sponsored evidence that was hard to audit, while independent reviewers struggled for years to obtain the full clinical study reports. When Cochrane researchers and the BMJ finally secured large troves of internal data, benefits proved small and specific: symptom relief measured in hours, with no solid proof of reduced complications or hospitalisation, alongside increased nausea and vomiting. Public money was committed at scale while independent scrutiny was blocked or delayed, and that sequence should never repeat.
Conflicts at this level carry predictable consequences across therapeutic areas. Companies face strong incentives to pursue new, patent-protected products over cheap, off-patent candidates, because margins and market exclusivity decide quarterly results. Marketing to prescribers and consumers has expanded massively, with US industry promotion across channels measured in tens of billions of dollars and growing over the past two decades; persuasion budgets often outrun investment in transparent, comparative trials that could reduce uncertainty for patients. Those choices shape formularies, coverage decisions, and the knowledge environment clinicians inhabit every day.
The record also includes repeated, high-value misconduct cases that would have ended careers in most sectors. Pfizer paid $2.3 billion in 2009 for off-label promotion and kickbacks tied to Bextra and other products, in what the Department of Justice called the largest healthcare fraud settlement at the time. GlaxoSmithKline paid $3 billion in 2012 over unlawful promotion and failure to report safety data across multiple drugs. Purdue Pharma pleaded guilty in 2020 to three felony counts related to opioids, including defrauding federal health programmes, and agreed to multibillion-dollar penalties. These cases display patterns of misbranding, concealment, and sales pressure that damage trust at the point of care.
Emergency powers during crises demand special vigilance because evidentiary thresholds change by law. Under the US statute for Emergency Use Authorization, products may be deployed on a “may be effective” standard when benefits are judged to outweigh known and potential risks, a bar below full approval; the framework exists for speed, not for certainty. Public communication often glossed this legal reality, and institutions did not always make limitations plain to clinicians and the public. Trust cannot survive that kind of shorthand.
Repurposed drugs sit at the centre of a different but equally structural problem. Off-patent candidates rarely attract funding for large, independent comparative trials because the commercial pay-off is limited, even when preclinical signals or early clinical data look promising. The result is a skew in the research portfolio that favours new molecules over cheap options that might serve many. Methodologists have documented how trials can be designed to miss potential benefits through late intervention, low dosing, or narrow enrolment, while unfavourable studies travel faster to publication than favourable ones when commercial incentives align. The same ecosystem that hides risk can also bury value.
(Dr. Makis repurposed drugs cancer protocol)
People paying premiums deserve research and regulation aligned with public need, not fee schedules negotiated with the regulated. The fee-for-review model must be replaced with independent appropriations that fund the full drug evaluation pipeline, with firewall rules that forbid agency operations from relying on industry cheques. Congressional analysts and health policy offices already quantify the scale of dependence; the case for structural change rests on their numbers, not on slogans.
Trial transparency needs to be universal and enforced. Every clinical study should be prospectively registered with full protocols and statistical plans, and the full clinical study reports and anonymised patient-level data should be posted on public repositories within a fixed time after completion, regardless of outcome. The Tamiflu saga shows that independent review of complete reports can change policy conclusions; the system should not rely on protracted campaigns to prise open data that ought to be open by default.
( Private equity (PE) firms now own almost 9% of U.S. hospitals, up from zero two decades ago. Over 100 million Americans are in medical debt & account for 530,000-600,000 bankruptcies annually )
Public funding should back head-to-head, pragmatic trials that answer questions patients actually ask. Comparative effectiveness studies between new entrants and best available cheap options should be routine before coverage at scale, and procurement should follow results rather than narratives. Agencies can coordinate with academic trial networks to deliver rapid, adaptive studies that keep costs down and external validity up, using existing care pathways rather than boutique centres. That blueprint exists in multiple countries and only lacks consistent mandate and money.
Sanctions must rise to match the harms. Corporate penalties that register as fees of doing business will not deter illegal marketing, data concealment, or kickback schemes. Enforcement should escalate to executive accountability when evidence shows knowing misconduct, and repeat offenders should face exclusion from public programmes until independent monitors verify clean practices. Fraud in drug marketing is not an abstract paperwork offence; patients bear its costs in morbidity, mortality, and diminished trust.
Employers and workers paying the bills should demand procurement that rewards value, not marketing heat. Benefit designs can steer toward drugs with robust independent evidence and away from me-too products without patient-centred advantages. Large purchasers can require data-sharing commitments and comparative trials as conditions for formulary placement. People funding the system have leverage, and purchasing power can reset incentives faster than editorials alone.
Medical journals and universities must purge conflicted practices that normalise ghostwriting and selective reporting. Editorial policies should require data deposition and make independent replication a condition of publication in high-impact outlets. Universities should align promotion criteria with rigorous, transparent science rather than volume counts padded by industry-written manuscripts. Senior editors have already said where the rot sits; institutions should now match words with operational rules.
Citizens did not choose a system where half of the regulator’s drug office runs on cheques from those seeking approval, where governments spend billions on stockpiles justified by partial data, and where landmark fraud cases recur with numbing regularity. Workers did not choose an insurance market that raises family premiums by thousands every few years while middle incomes stall. People would not choose a research agenda that neglects cheap, plausible treatments because no one can own them. They live with the consequences because incentives were set to favour revenue over reproducible knowledge, and oversight was bent to accommodate that preference.
Reform means dismantling dependency and rebuilding incentives that reward independent proof. Replace industry fees with public funding. Mandate full-data transparency with enforcement, not appeals. Fund pragmatic head-to-head trials that put cheap options on equal footing. Tie coverage and procurement to comparative value, not launch hype. Enforce the law against fraud with penalties that change behaviour at the top. People paying the premiums deserve a system that earns trust with clean methods, open data, and accountable governance, and nothing less will stop the drift toward higher costs and thinner evidence.
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Popular Information is powered by readers who believe that truth still matters. When just a few more people step up to support this work, it means more lies exposed, more corruption uncovered, and more accountability where it’s long overdue.
If you believe journalism should serve the public, not the powerful, and you’re in a position to help, becoming a PAID SUBSCRIBER truly makes a difference.
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