USD 12 billion is a lot of money. According to a new analysis, US physicians have received more than $12 billion in payments from the pharmaceutical and medical device industries over 10 years.
We’ve spoken previously about the issue of doctors receiving payments while also sitting on boards and committees that set guidelines. As I said then, we need doctors to be involved in the industry. For those who aren’t aware, I’m a medical advisor to Little Green Pharma, a medicinal cannabis company. We need doctors to help set policies, establish guidelines, and determine what is useful and what isn’t. But these two roles—industry involvement and regulatory decision-making—must remain separate.
The analogy I used previously still holds: you can’t play a game of sport and simultaneously be the umpire. It just doesn’t make sense. If you’re representing a particular interest in a discussion or debate, that’s fine—we need people to argue cases. But we also need independent entities to assess the merits of those arguments.
This topic is on my mind because of Vinay Prasad, an American haematologist and oncologist—an excellent guy. If you’re listening to or following this podcast, I’d certainly recommend checking out his work. In his most recent Substack post, he raises an important question:
Should drug companies be allowed to get their most costly products on the US market based on metrics like “killing more plasma cells” rather than proving that they help patients live longer or better lives?
Specifically, he questions whether MRD (Minimal Residual Disease) negativity at 9 or 12 months is a suitable basis for accelerated approval in multiple myeloma.
I’m not a haematologist, so I won’t go into the details. But essentially, what Vinay is arguing is that treating a single patient with myeloma already costs upwards of $600,000 per year, and this change could easily push costs to $1 million or more annually. And make no mistake—according to Vinay (and I’ll quote him directly here):
“MRD negativity does not have a strong correlation with living longer. The FDA’s own analysis shows a weak correlation. No analysis has been presented showing whether it predicts quality of life.”
Despite this, as Vinay noted, he was given just five minutes to speak at an inquiry. He was the only person present who argued against the approval.
I’ll quote him again:
“The FDA lives in a bubble where they only talk to people who lavish praise on them and engage far more with industry representatives than with critics of their policies. That’s fine—if their goal is to balloon healthcare spending until our country goes bankrupt, while failing to generate evidence that optimizes survival and quality of life for patients. Sadly, that seems to be the case.”
Those are Vinay’s words, not mine. But I certainly wouldn’t disagree with him.
Follow the Money
It looks like there could be 12 billion reasons why this is happening.
A letter published on March 28th in the Journal of the American Medical Association found that the industry made over 85 million payments to more than 820,300 physicians across 39 specialties between 2013 and 2022. This covered 57% of eligible doctors. Nearly 94% of those payments were related to one or more marketed medical products.
Researchers examined data from the Open Payments database, which was introduced under the Affordable Care Act (also known as the Sunshine Act) during the Obama administration. The data is publicly available—it’s hiding in plain sight. But let’s be honest: most people, myself included, don’t go looking for it.
There’s also another page, the Violation Tracker Industry Summary, which documents penalties since 2000. The total fines? $116.2 billion.
Just to highlight some of the biggest offenders:
- Johnson & Johnson: $24 billion (88 violations)
- Pfizer: Nearly $11 billion (98 violations)
The list goes on. You can check it yourself—these are all major names.
The Cost of Doing Business
There’s so much to unpack here, and we’ll probably do more discussions on this in future episodes. But one key takeaway is this: these massive fines haven’t bankrupted any of these companies. That tells you one thing—these corporations see them as just another cost of doing business.
One of the biggest fines ever imposed was over $3 billion against a company for illegally marketing antidepressants in the mid-2000s. Now, let’s be clear: no company likes paying billions in fines. But the fact that some of these corporations have been fined over 90 times in the last 20 years suggests that the penalties haven’t been enough to change their behaviour.
Conflicts of Interest Matter
Let’s go back to where we started—conflicts of interest.
Everybody has conflicts of interest, but when they are declared, at least we know where people stand. What really matters is that the people making the final decisions are not the same people who are advocating for those decisions.
It’s like a courtroom: the judge must be independent from the lawyers arguing their cases. The lawyers represent their clients—that’s their job. But the judge must make a fair decision based on the evidence. If the judge were being paid by one of the lawyers, we’d consider that a huge problem. We wouldn’t accept it.
We shouldn’t accept it in medicine either. But unfortunately, we’ve seen increasing corruption in medical practice, leading to declining public trust in health authorities. And I completely understand why.
The erosion of trust in public health has happened gradually, as more of this information has come to light. While much of it is available to the public, it is often buried or difficult to interpret. The medical profession itself has been far too accepting of official narratives from government agencies and academic institutions, often without questioning them.
We need to ask more questions—both as a profession and as individuals. Ultimately, personal health decisions should be in the hands of the individual. No two people are identical, and the idea that there is a one-size-fits-all approach to health is fundamentally flawed.
Closing Thoughts
Thanks for reading Doctor Joe Unplugged.
If you enjoyed this episode, please subscribe, like, and share. You can also follow us on social media for new content each week.
Sources
- Vinay Prasad’s commentary on the FDA drug advisory: Read here
- Research on US physicians receiving payments from the pharmaceutical industry: Read here
- Pharmaceutical industry violation tracker: View here
For more articles and insights, visit Doctor Joe Unplugged on Substack: Subscribe here
Dr Joe Kosterich – Doctor, Health Industry Consultant and Author
Doctor, speaker, author, and health industry consultant, Joe is WA State Medical Director for IPN, Clinical editor of Medical Forum Magazine, Medical Advisor to Medicinal Cannabis company Little Green Pharma and Course Chair, and writer for Health Cert. He is often called to give opinions in medico-legal cases, has taught students at UWA and Curtin Medical schools and been involved in post graduate education for over 20 years.
A regular on radio and TV, Joe has a podcast – Dr Joe Unplugged, has self- published two books and maintains a website with health information. He has extensive experience in helping businesses maintain a healthy workforce.
Past Chairman of Australian Tobacco Harm Reduction Association, current Vice President of Arthritis and Osteoporosis WA, Joe previously held senior positions in the Australian Medical Association and has sat on numerous boards.
