Pharmanomics: How Big Pharma Destroys Global Health

by Nick Dearden, Gareth Richards (Narrator)

In Pharmanomics, investigative journalist Nick Dearden digs down into the way we produce our medicines and finds that Big Pharma is failing us, with catastrophic consequences.

Big Pharma is more interested in profit than health. This was made clear as governments rushed to produce vaccines during the Covid pandemic. Behind the much-trumpeted scientific breakthroughs, major companies found new ways of gouging billions from governments in the West while abandoning the Global South. But this is only the latest episode in a long history of financializing medicine—from Purdue's rapacious marketing of highly addictive OxyContin through Martin Shkreli's hiking the price of a lifesaving drug to the 4.5 million South Africans needlessly deprived of HIV/AIDS medication.

Since the 1990s, Big Pharma has gone out of its way to protect its property through the patent system. As a result, the business has focused not on researching new medicines but on building monopolies. This system has helped restructure our economy away from invention and production in order to benefit financial markets. It has fundamentally reshaped the relationship between richer and poorer countries, as the access to new medicines and the permission to manufacture them is ruthlessly policed. In response, Dearden offers a pathway to a fairer, safer system for all.

Genres: Politics, Nonfiction, Economics, Audiobook, Science, History, Health

Audible Audio

Published November 14, 2023

Reviews

[Maaza · Rating 5 out of 5]

I admit that I am totally biased - because I have worked with Nick Dearden and think he is amazing - but this is a very good book. Nick explains multilayered and complicated issues in an accessible and clear way. And the book is about much more than the pharma industry - he touches on global trade, neoliberalism, the colonial and racist tendencies in philanthropy, and much more.

[David · Rating 2 out of 5]

The author takes a scattershot aim at the pharmaceutical industry, but hits nothing concrete. Its broadest focus, when it focuses, is on the financialization and greed of the pharmaceutical industry, but nothing about how it actually DESTROYS global health. Bottom line, for the author, big pharma destroys global health simply because its financial incentives do not align with the author's vision of the world.

[Shanna · Rating 2 out of 5]

Stars for information and its importance.
Otherwise long-winded and repetitive, with no call to action. For a book that promises it’s not all doom and gloom, what am I supposed to do with this information now?
Could’ve been condensed into a journal article.

[Saif Elhendawi · Rating 4.25 out of 5]

Nick Deadren covers the financialization and corporate greed that is rampant in Big Pharma, with a specific focus on the latest issues that came with the Covid-19 pandemic. Sadly, a lot of critique of Big Pharma especially during the Covid Era is colored by right-wing grifters and conspiracy theories, which dilutes legitimate and scientific critique of the industry. Works like this one are important in showcasing the real problematic tactics employed by Big Pharma companies that end up hurting patients worldwide.



The biggest culprit is the increased financialization of the economy that started in the 1990s and reached its peak in the 2007 financial crisis. In the Pharma sector this increasingly manifested in Pharmaceutical firms operating as hedge funds. Companies spend most of their revenues into stock buybacks, dividend payouts, mergers and acquisitions and legal defenses, rather than on medical or scientific research. Most early-stage research into diseases and drug development is funded by government grants and public universities (the people's money and taxes). Big Pharma companies then swoop in to acquire the patents and privatize the profits, while evading all the risks and costs of the early research stages. Companies leverage patent-based monopoly privileges to markup drug prices by thousands of percent over production costs. "Breakthrough treatments and vaccines are frequently priced well beyond the reach of patients and public health systems, leading to rationing or complete lack of access." During supply shortages, "firms have even demanded extreme contractual terms from governments, such as immunity from liability or pledging sovereign assets as collateral". This is absurd, given that the governments (and by extension the people) are the ones who mostly financed and sponsored the research to begin with. Furthermore, using a practice called "evergreening", companies make minor, non-therapeutic tweaks to existing drugs (such as placing an old tablet inside a new capsule shell) simply to extend their monopolies and block cheaper generic alternatives. Some companies even directly use "pay-for-delay" arrangements to essentially bribe generic manufacturers for staying off the market.



The question that keeps looping in your head as you read about all these tactics is: why are governments not interested in intervening or regulating these companies? The answer is lobbying and regulatory capture. Pharma companies spend hundreds of millions of dollars annually on political lobbying, campaign contributions, and maintaining a "revolving door" between regulators and corporate boards. Famously, before serving as US Secretary of Defense under President George W. Bush, Rumsfeld served for several years as the chairman of Gilead Sciences. He made a huge fortune from the bird flu countermeasures instituted by the government at the time. On another note, regulatory bodies such as the US FDA receive significant funding directly from corporate user fees. A tactic that is used to get approvals of expensive drugs with weak or inconclusive therapeutic evidence. The lack of regulation also allows for deceptive and predatory marketing that targets doctors and patients with exaggerated claims and downplays safety risks. A prominent example of this is Prude Pharma's marketing of OxyContin which fueled the opioid crisis that is still impacting lives today. There is also the practice of "disease mongering" where companies influence diagnostic criteria for diseases through funded research lobbies or through direct to consumer campaigns that convince healthy individuals they require medication. This was famously the case for Valium which was marketed to families as "Mother's Little Helper", encouraging people experiencing everyday levels of anxiety to take very strong tranquilizers.



Covid-19 acted as a global catalyst for a lot of these insidious tactics, pushing them to their extreme and demonstrating their danger on an unprecedented scale. Big Pharma already has a history of ignoring high-need diseases that are related to global health, such as malaria or tuberculosis. They are also notorious for their abuse of emerging pandemics to maximize profits and milk governments for as much as they are able to. Covid-19 was far from being a wakeup call but instead it displayed clearly their open resistance to technology-transfers, patent pools and temporary intellectual property waivers that could have saved thousands of lives. US Operation Warp Speed, German Government funds for BioNTech, and UK funding for Oxford was appropriated by major pharma companies as they retained 100% of the intellectual property rights and financial returns. This led to "the creation of nine new billionaires in just over a year". Big Pharma companies boycotted global knowledge pools such as the WHO's Covid-19 Technology Access Pool (C-TAP), forcing scientists in Africa and Asia to reverse engineer the vaccine independently. During the World Trade Organization conventions, a coalition of European and Western nations repeatedly blocked the TRIPS Waiver proposed by India and South Africa to temporarily suspend medical patents. "This hypocrisy shattered global trust in Western multilateralism and neoliberal trade rules". While Russia and China stepped in to provide mass aid to poorer countries and also initiated the sharing of technologies. Cuba is discussed specifically by the book as a good case study on how to achieve optimal medical outcomes and conduct groundbreaking scientific innovation while completely divorced from Big Pharma's profit motive or any market incentives. Thus, making the case for increased regulation and governmental intervention in this crucial sector.



Ultimately, this book analysis on how insidious and dangerous IP laws, monopolies, deregulation, etc. in the pharma sector can be easily used to comment on the behavior of corporations under capitalism more generally. Of course, the tactics are much more scary and horrific when it comes to healthcare, but there are other crucial sectors such as education, food and agriculture, transportation, etc. that suffer from similar predatory companies. Thus, a systemic lens would show that the problem is not with an individual "evil" company or even a specific industrial lobby group, but an underlying contradiction within capitalism itself. The book doesn't really delve into that political analysis itself, but it is still a must read for anyone who wants to understand the contradiction between profit incentives and global health.

[Sameera Nanayakkara · Rating 5 out of 5]

Nick Dearden’s ‘Pharmanomics,’ is a bold, revolutionary, and most importantly, a timely book which all medical professionals, specially all prescribers, ought to read. This well researched, well-presented narrative brings to light the unfortunate plight of the global health dilemma caused by financialization of the pharmaceutical industry where money stands way above in the hierarchy than the actual value placed upon human life. Any responsible global citizen, policy maker or humanitarian will find the book highly insightful. So, do not fail to read ‘Pharmanomics.’

[Theo Redelinghuys Lorente · Rating 3 out of 5]

Shows the financialisation of big pharma and it's effects globally very well, using Covid as a case study at several points however is at times long winded and repetitive

[Nikita · Rating 4 out of 5]

essential reading for biomedical science (+ adjacent) students/grads

[Jim · Rating 1 out of 5]

Catchy title, for sure, but there isn't really much here that hasn't already been told elsewhere, in abundance. Still, it collects it all in a pretty book by Verso, so it isn't all useless, just not very exciting or revelatory either. If you don't know what Dearden writes about here, then you are decades behind the story of the US government teaming up with the pharmaceutical industry (and other capitalists) to morph the health care industry into a for-profit behemoth. The COVID-19 pandemic didn't really expose anything, as this symbiotic relationship between capitalists and politicians is decades old, and so well-entrenched as to be nearly impossible to break. If the US government cared about the health and/or welfare of its citizens, we would have single payer health care, universal health care, free health care. Anything besides what we have. But... The US government is made up of people with money, lots of it, and many of them are in the pockets of capitalists, whether in the pharmaceutical industry or some other industry. It hardly matters which. Wealthy people help wealthy people get wealthier, fuck the rest. That is the US system of "governance". The US health care system is almost entirely about making money, lots of it, and almost not at all about health, or care. I hate the pharmaceutical industry almost as much as I hate the US government. The former is just working in the system, the latter created, promoted and maintains it. Of, by, and for the wealthy people. Democracy, my ass. Anyway. I thought the COVID-19 pandemic - which has hardly ended mind you, it just can't hold the attention of most people anymore - would make citizens realize who holds their survival in their hands, and hopefully cause a revolution of some sort. What it did instead was show how unwilling the wealthy politicians are to break up an industry that provides massive profits for them, and how hundreds of thousands of unnecessary deaths in the USofA, not to mention millions across the globe, mean absolutely nothing in the face of maintaining a system that not only keeps wealthy people wealthy, but keeps everyone else's survival beholden to the whims of these profiteers.
If this book surprises you, you should be ashamed.

[Kevin Strybos · Rating 5 out of 5]

As someone with an amateur understanding of economics and the financial sector, I found this book really insightful, relevant, and helpful. This book broadly yet clearly describes the (national and international) wealth and health inequality countries face and the multiple factors at play with a specific focus on public health and “Big Pharma”. While the criticisms laid out in the book were interesting and helpful for understanding BPs impact on global health, I especially appreciated the final chapters focused on ways governments and institutions are pushing back and acting on new strategies of medicine development.

[Phil · Rating 4 out of 5]

Great and very important book, a little bit redundant and scattered if you are interested in the area already. If it's your introduction, I strongly recommend it, and it does an amazing job at popularising a difficult area. Unfortunately my research is around it so feels a little bit flat and I didn't have the best time reading it.

[Rojo Dave · Rating 4 out of 5]

A deep dive into how neoliberalism turns our health systems into profit making industries for the benefit of the few and against the interests (health interests) of the rest of the world (more so of the global south). One suspects all of this, but reality is worse than what one can imagine; truly disgusting. More reasons to why neoliberalism is a cancer, and the "free market" is a myth.

[Pep Rey · Rating 4 out of 5]

I read the Spanish translation. It's a really interesting work if you work in the sector as I do as a pharmacist. The book exposes some key concepts that the industry is involved in such as their way of funding or the abuse of the intellectual property. Great summary about how the industry lived and acted in the COVID pandemic without people's interest.

[Joy · Rating 5 out of 5]

It's been a while since a book enraged me as much as this one! I'm too sleepy rn, but I'll add more thoughts later

[Gumbo_khan · Rating 5 out of 5]

All around amazing book. Gives me great ammunition to use when discussing my hatred for large pharmaceutical companies!

[Turtle Head · Rating 4 out of 5]

Appreciated this book as a recent history of big pharma during covid

[Nick Manners · Rating 3 out of 5]

Good first half, hard to read and not as relevant second half, doesn’t offer solutions, nor does it address talking points against itself

[Esteban Van · Rating 4 out of 5]

Good exploration of how the concentration of intellectual property rights by big capital warps global health

[Lani · Rating 3 out of 5]

As a pharmacy student, I was aware of the greediness and the lust for power of Big Pharma, but this book uncovered a whole new layer of disgust that I hold for these large corporations.

[Jade Smith · Rating 3 out of 5]

A tedious, if important and enlightening, read. I knew next to nothing about the economics of the pharmaceutical industry before this, and now know enough that I’m deeply upset by it.

[Clementine · Rating 3 out of 5]

3.5 🌟

Good info, not the most effective presentation.

[A · Rating 4 out of 5]

This book tells the story of the financialization of the pharmaceutical industry (and healthcare in general) primarily through the story of the Covid-19 pandemic, though other disturbing examples of Big Pharma’s greed are scattered throughout. This was also a good introduction to the conversation of decolonization of the Global South, which I must admit I did not know anything about (for shame). While Dearden tries to conjure some hope in his conclusions, I was left feeling the opposite.