Abstract

This chapter examines various structural and institutional loop-holes and market incentives that allow pharmaceutical companies to maximize profits at the expense of public health, create institutional corruption in academic and healthcare settings, and undermine the scientific integrity of medical research. Practices that are discussed include illegal off-label promotion and prescription of drugs, financial incentives and kick-backs to physicians to alter their prescribing behaviours, financial incentives to academic centres and journals, the deliberate creation and dissemination of biased research findings through ghostwriting, suppression of negative results, and widespread conflicts of interest. The wide-spread systemic nature of these problems means that solutions will have to be equally wide-spread and systemic, with unprecedented changes across multiple sectors.