Confessions from Within
Goetzsche shares his experience in the pharmaceutical industry, where research and marketing have become tools of manipulation. Companies falsify data, bribe doctors and journals, and trials are conducted for a pre-determined desired outcome. A culture of pressure and lies prevails, where honest professionals are forced to remain silent.
The Deaths of Asthmatics Were Caused by Inhalers
The author cites a case where a new inhaler caused fatal attacks, but the manufacturers concealed the risk and continued sales. This example shows how even life-saving medications can become dangerous when driven by commercial interests.
Shadow Marketing and Research
Pharmaceutical companies create "scientific" articles through PR agencies, bribing scientists for signatures. This creates an illusion of evidence and safety. Marketing masquerades as science, and regulators and journals become part of the sales system.
Organized Crime – The Business Model of Big Pharma
Pharmaceutical corporations act like the mafia – they lie, bribe, and falsify data, budgeting for future fines. This is legalized crime under the guise of medicine, where profit is prioritized over human lives.
Goetzsche provides high-profile examples: Pfizer – $2.3 billion, GSK – $3 billion, J&J – $1.1 billion, Abbott – $1.5 billion in fines and others. Behind these figures are deaths and ruined lives, yet no company has faced criminal punishment. The system continues to operate as before because crimes are embedded in its economic model.
Goetzsche emphasizes that even after high-profile scandals and billion-dollar fines, criminal practices do not cease. Companies continue to deceive regulators, influence doctors and government bodies, change drug names, and reintroduce them to the market.
Very Few Patients Benefit from Medications
Goetzsche shows that the overwhelming majority of medications do not provide real benefits to patients, especially when considering their side effects. He cites statistics indicating that only a small fraction of patients experience significant improvement, while millions bear risks ranging from mild disorders to fatal outcomes.
The author explains that clinical trials are built on narrow criteria, excluding complex patients, the elderly, and those taking multiple medications, thus the results do not reflect real effectiveness.
As a result, people believe in medications whose effectiveness has only been proven on "ideal" patients, who have nothing in common with real-life individuals from practice.
Clinical Trials Violate the Social Contract with Patients
The author claims that volunteers participating in trials are misled. They are promised that their contribution will help others and benefit society, but in reality, results are often concealed or falsified if they are inconvenient for the sponsor. Thus, patients risk their lives for false conclusions that promote commercial interests.
Conflict of Interest in Medical Journals
Goetzsche reveals how medical journals have become a dependent link in the pharmaceutical industry. Companies pay for publications, advertising space, sponsored issues, and editors receive significant fees and grants.
Many "scientific articles" are actually written by PR agencies and merely signed by well-known scientists. Such dependence turns journals into marketing tools rather than scientific ones.
Easy Money Corrupts
Goetzsche discusses how the financial system encourages corruption in medicine. Doctors receive bonuses, grants, sponsored trips, and "consulting" contracts from pharmaceutical companies. Even university researchers and clinics often depend on corporate funding. As a result, treatment decisions are made not based on patient benefit, but on economic advantage for the system.
What Are Thousands of Doctors on Industrial Salaries Doing?
Goetzsche describes how thousands of doctors around the world effectively work for pharmaceutical companies, getting paid to promote medications. Companies hire authoritative consultants and educators to shape the opinions of the medical community and patients through their influence. These doctors speak at conferences, write articles, and present marketing pitches as scientific facts, creating an illusion of independence.
Sales Problems
The chapter reveals how marketing becomes the core of business: clinical trials often serve sales rather than science. Results are manipulated, and negative data is concealed. Shadow authorship arises – when articles are written by PR agencies, and scientists merely sign their names. Pharmaceutical companies turn medicine into a marketing machine, creating demand for expensive and unnecessary medications. Prices for drugs are inflated many times over, and doctors and patients become hostages of a system where profit is prioritized over health.
Poor Regulation of Medications
The author shows that government agencies, tasked with ensuring drug safety, often have a conflict of interest. Former employees of pharmaceutical companies hold leadership positions in regulatory bodies, and the agencies themselves are funded by the industry. This leads to corruption and decision-making in the interests of companies rather than patients.
Switching Patients from Cheap Drugs to Expensive Ones
Here, the author explains how companies deliberately withdraw effective and cheap medications from the market to promote new, more expensive alternatives. Doctors are convinced that new drugs are safer and "more convenient to use," while old ones gradually disappear from pharmacies. As a result, patients are forced to pay more, even though their treatment essentially remains unchanged.
Psychiatry – A Paradise for the Pharmaceutical Industry
Psychiatry has become an ideal niche for the pharma business: diagnoses are vague, and results are hard to measure. The concept of "chemical imbalance" was invented by marketers to sell drugs for invented diseases.
Intimidation, Threats, and Violence as a Sales Method
The author recounts how pharmaceutical companies protect profits through intimidation and pressure: an example is thalidomide and the subsequent concealment of its consequences. Scientists publishing inconvenient data are harassed and deprived of grants. Goetzsche calls this "violence against the truth" and demands a moral revolution in science.
Myths about the Industry's Ruin
Goetzsche debunks the myths of pharmaceutical companies: drug prices are inflated, innovations come from universities, not corporations, there is no competition, and partnerships with the government serve business interests. Generics are just as effective but are pushed out, and medical education is used for brainwashing. The industry is not unprofitable – it is highly profitable and manipulates society.
The System's Failure Calls for Revolution
The modern pharmaceutical system kills more than it saves. Most medications are unnecessary, and trials and regulators are riddled with conflicts of interest. Goetzsche calls for the publication of all data, a rejection of surrogate endpoints, and the restoration of independence for doctors, patients, and science.
Let's Laugh at Big Pharma One Last Time
The author sarcastically describes how the industry invents diseases to sell "pills for everything." Under the slogan "money has no smell," pharma turns suffering into business. Goetzsche concludes the book with a call to stop believing in advertising and to restore common sense in medicine.
