Big Pharma is Still Giving Doctors Billion$$$ to Pimp Their Toxic Drugs

Most intelligent people understand why conflict of interest is a bad thing. When you have a vested financial or ideological interest in a matter, or social/familial ties that provide incentive to act in a certain way, then you cannot be considered an impartial actor. Irrespective of how honest you insist you are, rational outside observers understand you come prepackaged with potential bias, and that bias may cause you to act in ways that are not ethical and not in the public interest.

By 1971, according to a Social Security Administration analysis, around $1 billion per year was being spent by the drug industry to influence the prescribing habits of the then 180,000-strong army of US physicians (Silverman & Lee, 1974).

Like most criminal enterprises that have endured for decades, drug companies aren’t stupid. They understand humans love a freebie, and that even small gifts can bring greatly amplified returns in the form of increased drug prescriptions from the medical students and physicians they endow with everything from cheap nicknacks (branded pens, notebooks, desk pads, stress balls) to speaking fees and even strippers.

Despite the obvious concerns arising from this behavior, conflict of interest remains a pervasive problem in the medical industry - and the issue isn’t helped by the human tendency towards self-serving hypocrisy.

Palmisano & Edelstein surveyed 100 medical students in Alabama and 100 family planning nurses in California (Palmisano & Edelstein, 1980). The results, which they published in 1980, found 85% of medical students agreed it was improper for a public official awarding contracts to accept a $50 gift from a prospective bidder, but only 46% found it improper for a medical student to accept such a gift from a drug firm.

The nurses weren’t much better. While 97% agreed it was improper for a public official to receive a gift from a contractor, only 64% percent thought it was wrong for them to receive a $50 stethoscope from a drug company, and only 30% believed it wrong to accept a $50 book from a drug firm.

But things have improved since then, no?

No.

Big Pharma is still flooding the medical arena with shady gifts and payments - and physicians are still eagerly accepting them.

It’s no secret these endowments influence the prescribing habits of physicians. If they didn’t, the drug industry wouldn’t continue to spend billions on such gifting, year after year.

On November 16, 2020, the US Office of Inspector General (OIG) issued a Special Fraud Alert for pharma-funded speaker programs. Speaking fees are a favored avenue through which drug companies can get so-called “key opinion leaders” (i.e. industry-sponsored physicians and specialists) to promote their products under the guise of continuing education. As the OIG noted:

For purposes of this Special Fraud Alert, speaker programs are generally defined as company-sponsored events at which a physician or other health care professional (collectively, “HCP”) makes a speech or presentation to other HCPs about a drug or device product or a disease state on behalf of the company. The company generally pays the speaker HCP an honorarium, and often pays remuneration (for example, free meals) to the attendees. In the last three years, drug and device companies have reported paying nearly $2 billion to HCPs for speaker-related services.”

The alert noted the Feds had pursued civil and criminal cases against companies and individual HCPs involving speaker programs. These cases alleged, among other things, that drug and device companies:

• selected high-prescribing HCPs to be speakers and rewarded them with lucrative speaker deals, some receiving hundreds of thousands of dollars for speaking;
• made speaker remuneration contingent on sales targets (e.g., they required speaker HCPs to write a minimum number of prescriptions in order to receive the speaker honoraria);
• held speaker programs at venues or during events “not conducive to an educational presentation” - including adult entertainment facilities, wineries, sports stadiums, fishing trips, and golf clubs;
• held programs at high-end restaurants where expensive meals and alcohol were served (e.g., in one case, the average food and alcohol cost per attendee was over $500);
• invited an audience of HCP attendees who’d previously attended the same program or HCPs’ friends, significant others, or family members who did not have a legitimate business reason to attend the program.

To believe prominent lobby group PhRMA, the purpose of this carry on is “to help educate and inform other health care professionals about the benefits, risks, and appropriate uses of company medicines.”

Sure. Because nothing says “we only want you to use our products responsibly and when appropriate” like getting doctors liquored up at posh restaurants and taking them to strip clubs.

I don’t buy it, and neither does the OIG.

“OIG is skeptical about the educational value of such programs. Our investigations have revealed that, often, HCPs receive generous compensation to speak at programs offered under circumstances that are not conducive to learning or to speak to audience members who have no legitimate reason to attend.”

“…studies have shown that HCPs who receive remuneration from a company are more likely to prescribe or order that company’s products. This remuneration to HCPs may skew their clinical decision making in favor of their own and the company’s financial interests, rather than the patient’s best interests.” (Bold emphasis added)

As bioethicist Carl Elliot wrote in a 2014 issue of Neurology Clinical Practice (Elliott, 2014):

“If we have learned anything from a decade’s worth of litigation, it is that the pharmaceutical industry pays the vast majority of physicians for one reason: to market their drugs. And why would we have ever thought otherwise? Pharma companies are not charitable organizations. They are not in the business of education, or philanthropy, or poverty relief, or even—let’s be honest—health care. Their business is to manufacture and sell drugs. Unlike most any other businesses, however, pharmaceutical companies must go through an intermediary in order to sell their product. This places physicians in a position of singular trust. They stand between corporations and the vulnerable, sometimes desperate patients that those corporations call ‘customers.’” (Bold emphasis added)

How have physicians managed this delicate role of intermediary?

“In 2010, the pharmaceutical industry surpassed the defense industry as the leading defrauder of the federal government,” writes Elliot.

Which Medical Specialties Receive the Most Pharma Money?

In 2013, in response to negative media attention about Big Pharma’s shady gift-giving habits, and The Physician Payments Sunshine Act, the US federal government established an online database called Open Payments.

The Open Payments website reports that 57% of physicians received industry payments in 2024. Half of physicians received $172 in general payments (food, travel, consulting, engagements, entertainment, etc), while a similar proportion received $3,200 or more for “research”.

Sayed et al (2024) recently analysed data from the Open Payments platform from 2013 to 2022. They included payments for consulting services, non-consulting services (such as speaker or faculty fees), food and beverages, travels and lodging, entertainment, education, gifts, grants, charitable contributions, and honoraria made to physicians (allopathic and osteopathic). Their analysis included payments from industry to physicians across 39 specialties.

From 2013 to 2022, over 85 million payments with a total value of $12.13 billion were made by industry to 826,313 of 1,445,944 eligible physicians.

This means 57.1% of physicians received payments, with a median amount of $48 per physician; 93.8% of these payments were associated with 1 or more marketed medical products.

Excluding the year 2013 (when data were only available for August onward), the total value of payments was highest in 2019 ($1.60 billion) and lowest in 2020 ($864 million).

Additionally, the number of physicians receiving payments was highest in 2015 (468,164) and lowest in 2020 (359,509).

The total value of payments changed from $1.34 billion (to 443,367 physicians) in 2014 to $1.28 billion (to 424,417 physicians) in 2022.

Orthopedic surgeons received the greatest sum of payments at $1.36 billion, followed by neurologists and psychiatrists at $1.32 billion, and then cardiologists at $1.29 billion.

Which Drugs Are Associated With the Highest Spending on Gifts?

The 3 drugs associated with the most payments were the blood-thinner Xarelto (Johnson & Johnson, $176.34 million), anti-clot drug Eliquis (Bristol Myers Squibb/Pfizer, $102.62 million), and autoimmune drug Humira (AbbVie, $100.17 million).

The neurotoxin Botox (AbbVie), responsible for turning millions of terribly misguided women worldwide into grotesque duck-lipped parodies, came in at #8.

Ladies, stop it. Seriously, just stop, it looks ridiculous.

 

Ozempic (Novo Nordisk) - wildly popular with people who would rather risk abdominal pain, diarrhea, nausea, vomiting, potential blindness, gallbladder disease, pancreatitis and thyroid cancer than exercise and get a grip on their diet - came in at #22.

The three medical devices associated with the most payments were the da Vinci Surgical System ($307.52 million), Mako SmartRobotics ($50.13 million), and CoreValve Evolut ($44.79 million).

When Gifts Aren’t Enough, There’s Always Bribery

Just like the illicit drug industry, the pharmaceutical industry is incurably criminal.

The Journal of Law, Medicine & Ethics recently published a systematic review of bribery in the global pharmaceutical industry (Kohler et al, 2026). The report focused on drugs; cases involving medical devices were excluded from the review.

Using Organisation for Economic Co-operation and Development (OECD) Working Group on Bribery Phase Reports published between 1999 and February 2025, they found reported bribes amounted to about US$12.6 million, with sanctions exceeding US$1.1 billion.

The researchers found a number of patterns:

• Bribery was often approved by high-ranking managers.
• The use of intermediaries and complicated corporate structures to obscure bribes. Multiple cases revealed the involvement of subsidiaries, third-party vendors, or shell companies that processed payments disguised as legitimate transaction.
• Government officials, regulatory authorities, and healthcare providers were bribed through cash, gifts, luxury travel, and fraudulent research to gain market access, increase sales, or influence prescribing.

The United States had the highest number of investigations (fourteen cases), followed by Germany (three), Denmark (three), Greece (one), and Italy (one). These investigations implicated 19 pharmaceutical companies, with 14 companies explicitly named: BioTest, Novartis, Johnson & Johnson, Pfizer, Teva, Eli Lilly, Bristol-Myers Squibb, SciClone, Nordion, AstraZeneca, GlaxoSmithKline, Sanofi, and Novo Nordisk. The remaining cases involved companies that were either undisclosed or not publicly specified.

“These findings,” said the researchers, “underscore the systemic nature of bribery in the pharmaceutical sector and call for stronger oversight and accountability to protect public trust and equitable medicine access.”

Don’t hold your breath waiting for that to happen: America’s Groper-in-chief has invested millions in pharma stocks, and received record inauguration gifts from outfits like Pfizer and PhRMA.

Meanwhile, so-called regulatory agencies in the US, UK, Australia and Europe receive much or all of their funding from the drug companies they are supposedly regulating.

References

Elliott C. (2014). Relationships between physicians and Pharma: Why physicians should not accept money from the pharmaceutical industry. Neurology. Clinical Practice, 4(2), 164–167. https://doi.org/10.1212/CPJ.0000000000000012

Kohler, J., Khan, A., & Bowra, A. (2026). Bribery and the Global Pharmaceutical Industry: An Exploration of Patterns and Penalties in the Organisation for Economic Cooperation and Development Reports. Journal of Law, Medicine & Ethics, 1–11. doi:10.1017/jme.2026.10237

Palmisano, P., & Edelstein, J. (1980). Teaching drug promotion abuses to health profession students. Journal of Medical Education, 55(5), 453–455. https://doi.org/10.1097/00001888-198005000-00013

Sayed, A., Ross, J. S., Mandrola, J., Lehmann, L. S., & Foy, A. J. (2024). Industry Payments to US Physicians by Specialty and Product Type. JAMA, 331(15), 1325–1327. https://doi.org/10.1001/jama.2024.1989

Silverman, M., & Lee, P. R. (1974). Pills, Profits, and Politics. University of California Press, p 54-55.