The Pharmceutical Business: Pros and Cons

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By Dario Ruggiero (May 2015)


This article is neither against doctors nor Pharmaceutical companies. It is not a tool to promote alternative medicine, as well. The ultimate goal of this article is to improve the relationship between patients and the specialists who are supposed to assist them in taking care of their health. There are more way to do so.   

Essentially one can choose between the conventional approach and the alternative one (natural medicine). Each of these approaches has its pros and cons. This article is not to discuss the benefits of one method or another. Let me say only that while the conventional methods can be more effective in the short term, the natural medicine can be more effective in the long term. What I think is that each patient should have the freedom to choose the method which is better in line with his needs and way of life. 
This article focuses on the relations between patients and the medical system as a whole; it argues how, in the last decades, this relationship has been damaged by the intrusiveness of an ever-more ‘for-profit’ pharmaceutical industry. Pharmaceutical companies are ‘normal’ companies. They have to make profits in order to survive as organizations. To do so in the last decades they have adopted some well-defined strategies in order to increase their turnover. But all this has gone at the expense of the health of patients. In fact, more and more patients in developed countries suffer from more and more side effects and chronic illnesses. Therefore, the relationship between the medical system and patients is going to break down.
The aim of this article is to push for an improvement in the patients-doctors-pharmaceuticals relationship. This is because, we cannot talk about a long-term society, when there is a lack of health in that society. Health is a very important factor to survive in a long term perspective. So the ultimate goal of the medical system must be to actually assist the patients in achieving the best standard of health according to the approach (conventional vs alternative) he has decided to follow.
After a picture of the pharmaceutical business, the article describes what are the main strategies used by pharmaceutical companies in developed markets to increase their turnover, citing the main books published on the argument. In the last part of the article the alternative approaches have been described. This article is for all those want to know more about the pharmaceutical business and its effects on the medical system.
Thanks are due to Silvestro Montanaro (Journalist; Former Director of the RAI’s program 'C’era una volta,' supervisor of the documentary: 'Inventori di Malattie’), Gabriele Eminente (General Director of Doctors Without Borders Italy) and Jacky Law (Author of the book ‘Big Pharma') for their interviews on this topic (See the interviews with Silvestro Montanaro, Gabriele Eminente and Jacky Law). 
“Over the last decades, most human activities have suffered
a strong ‘process of financialization.’ Finance, money, profits
have penetrated every aspect of our life. Naturally, also the Health System
has been badly affected by this process…”
(Vincenzo Montanaro, LTEconomy, December 2015)
“Medicine has become a business. New illnesses are being invented…
Doctors are paid according to the number of their prescriptions and operations.
As a result new illnesses are invented and unnecessary surgeries are performed…
The ultimate goal is no longer health; it is turnover…”
(Gino Strada, Fondatore di Emergency,
Intervista a ‘Che Tempo Che Fa,’ 13-04-2013)
"Each year in the United States adverse drugs reactions cause 
An estimated 100,000 deaths and approximately 1,500,000 hospitalization"
(Big Buck, Big Pharma, Film Documentary)
1. The Value of the Pharmaceutical Business
2. The Pharmaceutical Industry
3. Big Pharma: the Top50 Pharmaceutical Companies
4. What Is Big Pharma: Some Books and Documentaries Against the Pharmaceutical Business
5. What Is Big Pharma: From Branding to Mongering - Structure and Tools of Big Pharma
6. Why  Big Pharma Is Looking for Increasing Profits
7. Another Kind of Health: Humanitarian Organizations and Alternative Medicine
8. Conclusions
1. The Value of the Pharmaceutical Business  
'Pharmaceuticals: a market of almost $1 trillion,
expected to grow to $1.3 trillion by 2018…’
According to IMS (November 2014), global spending on medicines was ‘only’ $605bn in 2005; in 2008 it was $795bn (31.4% more) and in 2013 (+24.4% over the 2008-2013 luster). It is forecast to reach nearly $1.3 trillion by 2018 (a value more than double that recorded in 2005), an increase of about 30% over the 2013 level. This level of growth—a compound annual growth rate of 4-7% on a constant currency basis—will be slightly higher than the 5.2% recorded over the past five years, due to the introduction of new specialty medicines, increased accessibility for patients and lower impacts from patent expiries in developed markets. Annual spending growth will spike in 2014, when absolute growth will be about $70 billion, up from the $40 billion growth recorded in 2013. Thereafter, growth will moderate though remain at higher levels than seen in the past five years.
Figure: Global spending on medicines and growth
Source: LTEconomy, elaboration on IMS (November 2014)
In 2013 the United States made up about 36% of global spending on medicines, followed by pharmerging markets[1] and the top 5 European markets. These are the main markets selected by IMS in its Global Outlook for Medicines.
Most countries will experience an increase in pharmaceutical spending per capita by 2018. Growth in the U.S. market will remain strong, disproportionate to its population growth. Despite high growth in pharmerging countries, there remains a large difference in pharmaceutical spending per capita versus developed markets. Only France and Spain will see a contraction of pharmaceutical spend per capita in 2018, due to policies intended to control spending growth. Highest growth is anticipated in China, where per capita spending is anticipated to grow by over 70% in the next five years.
Figure: Global spending on medicines in 2013: main markets
* Pharmerging: China, Brazil, Russia, India, Algeria, Argentina, Colombia, Egypt, Indonesia, Mexico, Nigeria, Pakistan, Poland, Romania, Saudi Arabia, South Africa, Thailand, Turkey, Ukraine, Venezuela, Vietnam.
** Top 5 European Markets: Germany, France, Italy, U.K., Spain.
Source: LTEconomy, elaboration on IMS (November 2014)
Demographic trends will be a significant driver of global demand for pharmaceuticals during the next five years: increase in diagnosis and treatment of chronic conditions and an aging population will drive developed markets, while population growth coupled with improved access to healthcare will drive emerging market growth.  
The developed markets—led by the United States, the major five European markets and Japan—are the primary drivers of growth, while the 21 pharmerging countries will increase their contribution to growth over the next five years and account for nearly 50% of absolute growth in 2018.  
2. The Pharmaceutical Industry
The story: a business born in…
The origins of the modern pharmaceutical industry date back in the late nineteenth century, with  the birth of some major companies: F. Hoffmann-La Roche & Co., founded in 1896 in Basel (Switzerland), and Eli Lilly founded in 1876 in the USA. Switzerland, Germany, Italy, United States of America, followed by the United Kingdom, Belgium and the Netherlands were the countries which gave birth to the first pharmaceutical companies. Some discoveries in the twenties and thirties, such as insulin and penicillin, gave strong boost to the development of the pharmaceutical industry, which in those years was still quite an emerging industry. Between 1940 and 1950 there were important legislative changes. In particular, it was introduced a clear distinction between the drugs marketable only by prescription (prescription drugs) and drugs which didn’t need any prescription (over the counter drugs). As a result, In 1960 four-fifths of sales of medicines were sold only by a doctor prescription, while at the beginning of the 30s most drugs were still sold without any prescription and almost half was prepared by local chemists. In the sixties the pharmaceutical industry witnessed a rapid expansion, thanks to some significant discoveries that led to the production and marketing of new drugs: the first birth control pills, cortisone, drugs for blood pressure, the first downers etc... These products were protected by permanent patents in a legislative framework still in its early stage. In the seventies the first drugs to treat cancer were introduced. Patent protection was limited to a fixed period (typically 20 years), thus leading to the emergence of the so-called 'generics,' that is, drugs made by the same principles as the original drugs, but sold at a reduced price. The birth of generics brought some changes in the market: 1) in general, generics benefited consumers who had access to more affordable medicines; 2) pharmaceutical companies started to witness a fall in their turnover as their major patented drugs expired; 3) there was a drastic reduction in the recovery time of investment in R&D, which eventually resulted in an increasing pressure on the prices of patented drugs. In the eighties and nineties, in order to contain public spending on medicines, governments started to make strong pressure on drugs prices. Pharmaceutical companies needed to be more efficient and innovative at the same time. To cope successfully with this challenge, they started to adopt strategies of Merger and Acquisition (M&A), which led to the birth of the ‘mega-companies’ that operate now in the pharmaceutical business (the so-called Big Pharma). In 1994, for example, American Home Products merged with Ayerst and Wyeth; in 1995 Glaxo merged with Wellcome, while Pharmacia merged with Upjohn; in 1996 the company now known as Novartis emerged from the merger of Ciba-Geigy and Sandoz; in 1999 Germany's Hoechst and France's Rhône-Poulenc gave birth to Aventis; In 2000 Pfizer merged with Warner Lambert and in 2003 acquired Pharmacia; In 2004 Aventis was acquired by Sanofi-Synthelabo. Along with strategy which increased their efficiencies, in the nineties ‘Big Pharma’ started to give an increasing emphasis on marketing and commercialization strategies. The diffusion of internet made possible to sell products online. At the same time in the Unitred States started the process now known as Direct-to-Consumer Advertising (DTC) through commercials on the Radio and Television. Finally, in the eighties other players emerged: biotechnology startup. These were small companies operating in the field of molecular biology. However, this sector still occupies a small portion of the pharmaceutical market.
The structure
The pharmaceutical business includes three main sectors: Pharmaceuticals, Biotechnology and Life  Science and Medical Device. The Pharmaceuticals sector is dominated by the so-called ‘ethical drugs,’ that include conventional drugs and more complex drugs (e.g, vaccines) for which prescription is required. Ethical drugs represent  the core sector for the big multinational pharmaceutical companies. Pharmaceuticals include "over the counter" drugs (OTC), that is, drugs marketable directly to consumers without doctors’ prescription. Both ethical and OTC drugs can be either ‘branded’ or ‘generic’ (unbranded). The Biotechnology Industry encompasses medications made from more complex natural molecules, often created from living cells. The Life Science Medical Device consists of instrumentation and equipment used in the pharmaceutical and biotech industry. 
3. Big Pharma: the Top50 Pharmaceutical Companies 
‘Almost $600bn the global sales of the Top50 pharmaceuticals companies in 2013 –
the value is equivalent to the aggregate GDP of the bottom 82 countries (almost half) in the world.
Top5 global sales were $205bn - equivalent to the GDP of the bottom 55 countries in the world.’
Figure– Top50 pharmaceutical companies: global sales in 2013
Source: LTEconomy, elaboration on IMS (June 2014)
The following table contains information on the sales of the so-called Big Pharma, that is, the leading pharmaceutical companies in the world. They are listed according to the value of their turnover in 2013 and their turnover is compared to that of 2005. In 2013 the first pharmaceutical company in terms of turnover was Novartis ($46bn), with an increase of 84.4% over 2005. Pfizer, with sales of $45bn, is the number two pharmaceutical company (although it recorded no substantial increase compared to 2005). Roche, based in Switzerland, is third (with a turnover of $39.1bn, a value more than tripled compared to 2005). The French Sanofi ranks fourth (with a turnover of $37.7bn and an increase of 'just' 16.6% compared to 2005). Merck & Co. is the fifth largest pharmaceutical company ($37.5bn in 2013, an increase of 70.5% compared to the value of 2005). Overall, the Top5 pharmaceutical companies in 2013 had a turnover of $205.4bn, +50% from the $136.5bn made by the same companies in 2005. The Top10 pharmaceutical companies had a turnover of $328.4bn, and the Top20 companies recorded a turnover of $466.5bn. Overall, the Big50 recorded a turnover of 598.4 billion dollars in 2013.
Table – Top20 pharmaceutical companies in 2013
Company Country Sales (2005) - $m Sales (2013) - $m % change
Novartis Switzerland                  24,960                  46,017 84.4%
Pfizer USA                  44,280                  45,011 1.7%
Roche Switzerland                  12,900                  39,143 203.4%
Sanofi France                  32,340                  37,701 16.6%
Merck & Co USA                  22,010                  37,519 70.5%
GlaxoSmithKline England                  33,960                  33,055 -2.7%
Johnson & Johnson USA                  22,320                  26,475 18.6%
Astra Zeneca England                  23,950                  24,523 2.4%
Eli Lilly India                  14,650                  20,119 37.3%
AbbVie USA  -                  18,790 -
Amgen USA                  12,900                  18,192 41.0%
Teva Pharmaceutical Industries Israel                    4,700                  17,563 273.7%
Bayer Germany                    7,560                  15,594 106.3%
Novo Nordisk Denmark                    5,360                  14,886 177.7%
Boehringer Ingelheim Germany                  10,840                  14,468 33.5%
Takeda Japan                    8,530                  13,591 59.3%
Bristol-Myers Squibb USA                  15,250                  12,306 -19.3%
Gilead USA                    1,810                  10,804 496.9%
Astellas Pharma Japan                    8,040                  10,431 29.7%
Daiichi  Sankyo Japan                    3,060                  10,268 235.6%
Source: LTEconomy, elaboration on IMS (June 2014)
4. What Is Big Pharma: Some Books and Documentaries Against the Pharmaceutical Business
Many books have been written and many documentary-films have been released on the increasing (often deemed negative) influence of multinational pharmaceutical companies on the global health system. Many of these books and documentaries denounce that the search for profits in this companies is prior to the search for better health. In such a way, many companies have become multi-billion dollar companies like Novartis and Pfizer. Communication campaigns plays a leading role in increasing the revenues of these companies in both developed and developing countries.
One of the first book showing how a small number of corporations have come to dominate the global healthcare agenda is Jacky Law’s Big Pharma: Exposing the Global Healthcare Agenda (2006). This book revealed a system in which the relentless pursuit of profit was crowding out the public good. Effective regulators were under intense pressure from corporate lobbies, and companies spent more money on marketing than they spent on research and development. Meanwhile, the cost of new drugs was rising relentlessly, while the number of original new products was declining. It was a book written in 2004, and, according to Jacky Law (LTEconomy, December 2014), the landscape has changed since then, not only because the internet has given voice to patients for the first time, but also because there are now requirements that medicines show value in the real world rather than the confines of a clinical trial.
Other books on the topic are the following (you can finde more details on the PDF version of the article):
Marcia Angell (2005), The Truth About The Drug Companies: How They Deceive Us And What To Do About It. 
Howard Brody (2007), Ethics, the Medical Profession, and the Pharmaceutical Industry.
Greg Critser (2007), Generation Rx: How Prescription Drugs Are Altering American Lives, Minds, and Bodies.
Merrill Goozner (2005), The $800 Million Pill. The Truth behind the Cost of New Drugs
Jerome P. Kassirer (2005), On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health. 
Ray Moynihan (2006), Selling Sickness: How the World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients. 
As well as books, many documentary-films highlight the increasing role of pharmaceutical business on the global health system. The following box gives some details on some of the best documentaries on the issue.

Big Pharma: Main Documentaries

BIG BUCKS, BIG PHARMA Marketing Disease & Pushing Drugs
(Media Education Foundation, 2006) –
This is a clear and well-done documentary which explains the main strategies used by the big pharmaceutical companies to make profits and how these strategies can cause negative effects in patients’ health. The documentary has identified four main strategies: 1) Branding Drugs, through Direct to Consumer Advertisings; 2) Swimming in pills, by creating the so-called ‘me-too’ drugs; 3) Disease Mongering, by changing guidelines for normal health standards; 4) No free lunch, that is directing promotional efforts to medical professionals.
Inventori di Malattie (Inventors of Deseases)
(Italy’s broadcast, RAI 3, conducted by the Journalist Silvio Montanaro, 2013)
This is a documentary made as part of the Italian RAI’s program’s ‘C’era una volta,’ (1999-2013). In this documentary, Silvio Montanaro shows how health has become a ‘big business.’ Pharmaceutical companies are now financial corporations which are in continual search for profit. So, in order to increase their sales, they literally ‘create new illness.’ They do so by using well-planned communication campaigns which make patients fell ill even if they are not ill, or use vaccines where there is no actual risk of an epidemic.
5. What Is Big Pharma: From Branding to Mongering - Structure and Tools of Big Pharma 
Big pharmaceutical companies are subject to all the economic rules to which are subject other sectors: increase their sales to be economically sustainable. While in the developing markets their main customers are the local and national governments, in the developed market big attention is given to patients. Let’s focus on developed markets. As well described in the documentary Big Bucks, Big Pharma Marketing Disease & Pushing Drugs, there are four strategies to increase the market of pharmaceuticals: 1) Branding Drugs; 2) Creating me-too drugs; 3) Disease Mongering (changing guidelines); 4) Promotional efforts to medical professionals.
Branding drugs
In developed countries, pharmaceutical companies traditionally promoted their drugs to doctors. Now, especially in the United States, they are targeting directly the end consumers, the patients. This communication strategy takes the name of Direct to Consumer Advertising (DTC). DTC advertising of drugs uses the same techniques as advertising for other commodities: branding products by associating them with positive emotions and images of happy people living fulfilling lives. The positive images of happy, healthy people in drug advertising can be misleading in terms of the safety of the drugs. Adverse effects lies behind the door, while ever more money is spent in advertising drugs.
Creating ‘me-too drugs’
Most of the new drugs introduced in the market are only compared to placebos. They don’t represent real innovations compared to old drugs. That is resulted in an explosion of new drugs, most of which are no better than the drugs that were already available. There are many duplicates of the same drugs, as in the case of allergy medications, with about the same effectiveness. These are known as “me-too” drugs. These “me-too” drugs are cheaper for the pharmaceutical companies to create because they require little research and innovation. The competition, however, moves ‘from the research field to the advertising field.’ This competitive marketing drives up the prices for medication as costs are passed along to consumers.
A classic example of this is the case of Nexium. When the maker of Prilosec, AstraZeneca, was faced with the expiration of their patent, worth 6 billion dollars a year, they introduced Nexium as a new pill to treat heartburn and acid reflux. There was only one small chemical difference in its makeup and it had almost exactly the same effectiveness and side effects as Prilosec. Only the image was new. Consumers and doctors, however, were encouraged to switch to Nexium instead of a cheaper generic or over-the-counter version of the same drug. A big advertising campaign started and representatives for AstraZeneca were told to start promoting Nexium even before the patent on Prilosec expired.
Disease Mongering
This strategy is perhaps the most dangerous one. It consists in making consumers think they are seek even when they are not really seek. The market of ‘real’ seek people is expanded to the larger market of healthy people. How do they do this? One of the methods is to change guidelines for ‘normal’ health standards as of to extend the number of people defined as sick. This has happened with standards for blood pressure and cholesterol. Another way is represented by educational campaigns.
The fact is that pharmaceutical companies actively search for new diseases to be treated with old drugs in order to better amortize the costs spent to create those drugs. The case of Paxil and the Social Anxiety Disorder is instructive. The makers of Paxil, GlaxoSmithKline, hired a public relations firm to coordinate a major campaign to increase awareness of Social Anxiety Disorder, a condition, which Paxil had been approved to treat. Some experts question whether people who are just a little shy have become convinced that they have a serious condition which requires medication.
The problem is that people who are prescribed medicine that they don’t really need may suffer from serious side effects. The use of anti-depressants by children, for example, has been linked to
increased risk of suicide.
Promotional efforts to medical professionals
Meals, trips, tickets to events, free samples of drugs. These are the main tools through which sales representatives incentivize doctors to prescribe branded drugs instead of generic ones. The combination of DTC advertising, visits to doctors by sales representatives, and free samples all come together when a patient visits a doctor and complains of a specific ailment. 
6. Why  Big Pharma Is Looking for  Increasing Profits  
Pharmaceutical companies are normal firms. As such they have to increase their sales and profits in order to survive in an ever-more competitive market. That means to find more and more patients to cure. Moreover, the biggest pharmaceutical corporations are companies listed in the stock market. Managers are forced to increase sales and profits in order to increase the value of the company’s shares.
“…Up to 40-50 years ago, health was considered a 'universal heritage' and the doctor was considered the guardian of this heritage, the person you could trust to preserve your health. Now things have changed: health is no longer the primary concern… ‘Increasing stock market performances’ is the primary objective of big pharmaceutical companies…. The mission of improving health has been completely replaced by the mission of making profits: in the long run, a listed company with steady-low returns is doomed to fail ….”
Silvestro Montanaro
(Journalist; Former Director of the RAI’s program 'C’era una volta,' supervisor of the documentary: 'Inventori di Malattie')
December, 2014 (
7. Another Kind of Health: Humanitarian Organizations and Alternative Medicine 
This paragraph is dedicated to the emerging of a lateral medical system, a medical system made of humanitarian ‘non-profit’ organizations which helps the most needy people, and made of those doctors and professionals who tried, have tried and are trying to create an alternative way of health based on preventive rather than curative medicine.
Humanitarian ‘non-profit’ organizations
Ensure care and treatment with ‘neutrality’ and ‘impartiality’ all over the world. This is the goal of some humanitarian ‘non-profit’ organizations operating in the field of medical assistance. People who need health assistance should get it whether they are poor or rich. Too often, however, many people, especially in developing countries, don’t even get the most basic emergency medical services. Why? The lack of facilities, inadequate organizational models, lack of human and financial resources, a system ever more profit-oriented are some (not-exhaustive) of the factors.
In order to face the lack of health assistance for these needy and poor people, some non-profit organizations have been created. Two of these are doing a great job around the world: 1) Doctors Without Borders (also MSF) which was set in 1971 and now operates in more than 70 countries; 2) Emergency, an Italian organization born in 1994.
According to Gabriele Eminente, General Director of Doctors Without Borders, the activities of such organizations are set to grow in the future because traditional areas of intervention (countries hit by conflicts and epidemics) are expected not to decrease, while new emergencies are set to rise (countries affected by climate-change related disasters and poor healthy conditions in increasing megalopolis).  
'It’s not good news to say, but what I think is that there will be a growing need for MSF in future. Why? There are more than one reason:
1) the traditional areas of intervention will not decrease;
2) At the same time, there are new emerging needs;
3) there is a growing number of ever larger urban conglomerates…'
Gabriele Eminente
(General Director of Medical Without Borders - Italy)
December, 2014 (
Re-addressing medical professionals
Together with these humanitarian ‘non-profit’ organizations which operate on the field, some other non-profit organizations have been created in order to change the way the medical system thinks and works. One of these is No Free Lunch, created by Bob Goodman in 1999,  with the goal to educate medical professionals about the damaging influence of Big Pharma. An ever-more growing number of activists around the world are trying to fight against the increasing lobbying power of the pharmaceutical industry in order to put once again the health of the patients at the center of the global medical system.
Alternative medicine
This is not certainly the appropriate document to study the pros and cons of alternative medicines. However, it is useful to give the readers the main basics of these methods and mention some of the most important and effective approaches. Most of these methods are based on the assumption that what the conventional medicine call illness are ‘symptoms’ of an excessive presence of toxic factors in our organism. Curing (Hiding) these symptoms is a mistake. What should be cured is the excessive level of toxic elements. Numerous methods have been developed in order to reduce such a level of toxic elements. All of these are included in the field of the so-called alternative medicine. Just to mention some of these: homeopathy, naturopathy, chiropractic, energy medicine, various forms of acupuncture, traditional Chinese medicine, Ayurvedic medicine, Hamer’s German New Medicine. Some of the therapies which seem to be more effective, especially in order to cure chronic illness, are the Gerson Therapy (based on the use of enema, together with a fruit-Juice-based diet) and the Shelton Hygiene System (which is based on the use of fasting, together with a raw-fruit and vegetable diet). Finally, many of these systems focus on the importance of the relations between soul, spirit and the body; mental serenity is essential to regain health.
8. Conclusions
Health is the essential element for a thriving, harmonious and happy society. Patients need to get the best assistance in order to keep healthy. The relationship between patients and the medical system is an essential element for the development and the survivor of our society. All the actors involved in this relationship (politicians, pharmaceuticals, doctors, alternative doctors) should work together in order to improve it. A society without ‘real health’ is doomed to decline… 

Abramson John, (2005), Overdosed America: The Broken Promise of American Medicine.

Angell Marcia, (2005), The Truth about the Drug Companies: How They Deceive Us and What to Do about It.

Avorn Jerry, (2005), Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs.

Bell Robert, (1984), Impure Science – Fraud, Compromises and Political Influence in Scientific Research.

Brody Howard, (2007), Hooked: How Medicine’s Dependence on the Pharmaceutical Industry Undermines Professional Ethics.

Critser Greg, (2007), Generation Rx: How Prescription Drugs are Altering American Lives, Minds, and Bodies.

Ethil Douglas-Hume, (1947),  Bechamp or Pasteur? A Lost Chapter in the History of Biology.

Gray Nicole, (May 2006), A Special Report on the World’s Top 50 Pharma Companies.

Greider Katherine, (2003),The Big Fix: How the Pharmaceutical Industry Rips Off American Consumers.

Goozner Merrill, (2005), The $800 Million Pill: The Truth Behind the Cost of New Drugs.

IMS Institute for Healthcare Information, (November 2014),  Global Outlook for Medicines  Through 2018.

IMS Institute for Healthcare Information, (June 2014),  Pharma 50.

Kassirer Jerome P., (2005), On the Take: How Medicine’s Complicity with Big Business can Endanger your Health.

Lanctot Ghislaine, (2002), The Medical Mafia.

Law Jacky, (2006), Big Pharma: Exposing the Global Healthcare Agenda.

LTEconomy, (December 2014), Interview with Gabriele Eminente (General Director of Doctors Without Borders Italy),    

LTEconomy, (December 2014), Interview with Silvestro Montanaro (Journalist; Former Director of the RAI’s program 'C’era una volta,' supervisor of the documentary: 'Inventori di Malattie’),  

LTEconomy, (December 2014), Interview with Jacky Law  (Author of the book ‘Big Pharma'),  

MEDIA EDUCATION FOUNDATION, (2006), ‘Big Bucks, Big Pharma: Marketing Disease & Pushing Drugs’, Film – Documentary.

Moynihan Ray and Cassels Alan, (2006), Selling Sickness: How the World’s Biggest Pharmaceutical Companies are Turning Us All into Patients.

RAI 3, (2013), ‘Inventori di Malattie (Inventors of Deseases)’, Documentary film, conducted by the Journalist Silvio Montanaro.

Reidy Jamie, (2005), Hard Sell: The Evolution of a Viagra Salesman.

The Australian Vaccination Network, (1998),  Vaccination Roulette: Experiences, Risks and Alternatives.

World Health Organization, (1978), Primary Health Care – The Declaration of the Alma Ata Conference.




Media Education Foundation -


Interviews with Gino Strada:

- Che Tempo Che Fa (03-04-2013) -

- Che Tempo Che Fa (17-05-2014) -




This article by Dario Ruggiero
is licensed under a Creative Commons Attribuzione - Non commerciale - Non opere derivate 3.0 Italia License


[1] To know what countries are included in the definition of Pharmerging markets used by IMS, see the following page.


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