Deadly Medicines and Organised Crime: How Big Pharma has Corrupted Healthcare by Peter Gøtzsche (review)

From the title, Deadly Medicines and Organised Crime: How Big Pharma has Corrupted Healthcare, Peter Gøtzsche makes the thesis of his book very clear. Not only does the pharmaceutical industry contribute to detrimental health outcomes through biased research, deceptive marketing, and disease mongering, but the industry’s business model meets the criteria of an organized criminal operation. Gøtzsche argues for this in two parts. First, he defines organized crime by drawing upon the United States Organized Crime Control Act of 1970, the centerpiece of which is the Racketeer Influenced and Corrupt Organizations Act (RICO) (18 U.S.C. §§1961–1968). RICO prohibits deriving income from a pattern of racketeering activity, including (among other things) murder, kidnapping, robbery, bribery, extortion, and dealing in a controlled substance. Second, he argues that big pharma derives much of its income from repeated racketeering activities. He does this in part by laying out his ‘hall of shame,’ which is a list of cases in which large pharmaceutical companies have agreed to pay settlement fines for fraud, illegal marketing, misrepresentation of research results, and other offenses, and in part by examining various deceptive activities that are standard in the industry, including manipulation of clinical trial results, coopting of university researchers, ghost writing, and deceptive marketing. Big pharma, he argues, engages in racketeering activity so often that “there can be no doubt that its business model fulfills the criteria for organised crime” (38). Gøtzsche is not alone in comparing the pharmaceutical industry to an organized criminal enterprise. In a striking passage, Gøtzsche quotes Peter Rost, a former Pfizer marketing vice president, as follows:

It is scary how many similarities there are between this industry and the mob. The mob makes obscene amounts of money, as does this industry. The side effects of organized crime are killings and deaths, and the side effects are the same in this industry. The mob bribes politicians and others, and so does the drug industry…. The difference is, all these people in the drug industry look upon themselves—well, I’d say 99 percent, anyway—look upon themselves as law-abiding citizens, not as citizens who would ever rob a bank…. However, when they get together as a group and manage these corporations, something seems to happen… to otherwise good citizens when they are part of a corporation. It’s almost like when you have war atrocities; people do things they don’t think they’re capable of.

(38) [End Page E-40]

While Gøtzsche’s overall thesis is that big pharma is an organized criminal operation, the majority of his book is devoted to elaborating standard criticisms of the pharmaceutical industry. For example, he includes chapters arguing that very few patients benefit from new blockbuster drugs; that clinical trials tend to be biased; that conflicts of interest among both academic scientists and journals are rampant; that companies repeatedly fail to report unwanted results; that drug regulation is inadequate; and that industry often relies on threats of various kinds to protect sales. Most of the book covers terrain that has been covered elsewhere, including by two former editors of the New England Journal of Medicine—Marcia Angell, in The Truth about the Drug Companies: How They Deceive Us and What to Do about It (2004), and Jerome Kassirer, in On the Take: How Medicine’s Complicity with Big Business Can Endanger Your Health (2005). Given this, it is fair to ask what, if anything, Deadly Medicines adds to the existing body of literature.

The main virtue of Gøtzsche’s book, and the primary thing that it adds to the existing literature, is a wealth of detail. Gøtzsche, a co-founder of the Cochrane Foundation and director of the Nordic Cochrane Centre, is a physician and medical researcher who has worked in, and commented on, the pharmaceutical industry for many years; he has published over 50 articles in the ‘big five’ medical journals (Annals of Internal Medicine, BMJ, JAMA...