The United States is the most medicated country in the world, with 70 percent of Americans using at least one prescription drug daily. The U.S. also has the highest rates of obesity, heart disease, childhood illness, and autoimmune disease, yet it often touts its health care and medical research as the best in the world.1
The medical model in the U.S. focuses on addressing the symptoms of disease and illness through the widespread use of pharmaceutical products rather than dealing with the root causes of disease. Lifestyle choices are rarely addressed and alternative forms of medicine are often mocked, despite most of them being around for decades to centuries longer than western medicine. Although diet has long been known to play a significant role in maintaining good health, medical doctors receive relatively little training on the topic of nutrition—on average only 19.6 hours throughout their entire 15,000 hours of education.2
To understand how the “pill for every ill” approach became the underpinning of the U.S. medical model, it is important to understand two factors—the history of how allopathic medicine practiced by medical doctors came to dominate health care in the U.S., and the fact that pharmaceutical companies provide a significant source of funding for medical school education and textbooks.
Rockefeller Capitalized on Oil Industry by Creating Pharmaceuticals
During the first half of the 19th century in the U.S., much of the model for health care was based around natural and holistic approaches such as herbs, homeopathy, and chiropractic care.3 In the early part of the 20th century, European pharmaceutical companies in the U.K., Germany, Switzerland and the U.S. were expanding their product lines.
The oil industry was booming and German pharmaceutical companies had begun developing synthetic vitamins out of petroleum byproducts known as petrochemicals. Billionaire John D. Rockefeller, who founded Standard Oil, recognized the opportunity to further expand markets for the oil industry by using petrochemicals to make pharmaceutical drugs and synthetic vitamins and purchased German pharmaceutical company Farben, now known as Bayer.4
The Flexner Report Eliminates Majority of Natural Healing Doctors and Education
In partnership with Andrew Carnegie, Rockefeller hired Abraham Flexner, who released the “Flexner Report” in 1910, which reshaped the practice of medicine in America forever. Flexner himself had attended Johns Hopkins University and had developed a distaste for “nonconformist” approaches to health and healing, which he deemed as “quackery.”5 His report concluded that there were too many doctors and medical schools in the U.S. and that natural healing modalities were unscientific and he advocated for their closure.6
The Flexner Report was then submitted to Congress and later adopted as law. Any medical school that agreed to adopt the scientific paradigm-focused recommendations outlined in the Flexner Report received large grants from the Rockefeller Foundation. Through this funding, virtually all other traditional healing arts were eliminated and, by 1930, only 76 percent of the 168 existing schools educating physicians remained.5
Boundaries Between Big Pharma and Medical Field “Hard to Disentangle”
Fast forward to the present and it is obvious that there are many blurred lines between medical care and the pharmaceutical industry. Not only do pharmaceutical companies continue to provide outsized funding of medical schools, medical textbooks, and medical associations, the pharmaceutical industry also spends a lot of money funding the legacy and online digital media, as well as U.S. lawmakers at the state and federal level.
“The truth is, it’s hard to disentangle medical education from whatever the prevailing culture is in medicine, including ways of thinking or beliefs of the day about diagnosis or treatment,” said Elia Ai Jaoude, MD, a psychiatrist who also went through medical school “And currently, the pharmaceutical and medical device industries continue to have much influence over the shaping of beliefs.”7
Opioid Crisis is Prime Example of Pharmaceutical Industry Influence
A recent example of how the pharmaceutical industry influences the practice of medicine is the opioid crisis, which has resulted in thousands of deaths and even more lives impacted by addiction. For years, representatives of the pharmaceutical industry set out to wage an aggressive marketing campaign in which they intentionally lied to and misled physicians about the safety of opioids and the potential for addiction. Harvard Professor and former editor-in-chief for the New England Journal of Medicine Marcia Angell, MD said in 2009:
Drug manufacturers paid doctors and movie stars to promote more aggressive pain treatment. The companies also created campaigns for their sales forces, tying bonuses to opioid sales and holding contests to reward top earners.8
Johnson & Johnson Reps Gave Prizes to Doctors Prescribing High Numbers of Opioids
One pharmaceutical company that promoted aggressive pain treatment using opioids was Johnson & Johnson, which courts of law found created PowerPoint presentations promising prizes for physicians who sold the highest amounts of their extended-release opioid Nucynta (tapentadol). Prizes included Caribbean Cruises and Sony home theater systems.8
Courts Deem Pharmaceutical Company Marketing as “False, Misleading, and Dangerous”
Federal judges throughout the country have ruled against various pharmaceutical companies for their aggressive and misleading marketing, including an Oklahoma judge who stated that Johnson & Johnson had engaged in “false, misleading, and dangerous marketing campaigns” causing “exponentially increasing rates of addiction, overdose deaths” and opioid-addicted babies.8
Throughout the pharmaceutical industry’s marketing campaigns, from 1997 to 2002, pain relief prescriptions in the U.S. increased from roughly 670,000 prescriptions to 6.2 million prescriptions.8 Attorney John Brownlee pointed out that Oxycontin was mostly about making money for pharmaceutical companies:
The genesis of OxyContin was not the result of good science or laboratory experiment. OxyContin was the child of marketeers and bottom line financial decision making.8
Physician’s Trust in Drug Companies Begins in Medical School
According to Joel Lexchin, MD, who was once an emergency room physician and now teaches health policy, the issue of physician trust in the pharmaceutical industry stems back to medical school. Dr. Lexchin wrote a book on the topic entitled Doctors in Denial: Why Big Pharma and the Canadian Medical Profession Are Too Close For Comfort.7
In his book, Dr. Lexchin outlined the many ethical dilemmas that arise from the entanglement between medical school students and the drug industry, including the companies paying university educators and the development of relationships with students early—which has been shown to impact the doctors prescribing habits, the co-authoring of biased textbooks, and research funding and findings that may be skewed in a drug company’s favor.
Medical School Research Funded by Big Pharma
Dr. Lexchin said that even when funding seems charitable, it is not uncommon for drug companies to benefit because they are promoting research in particular areas with a particular slant to them. He gave the example of a pharmaceutical company interested in developing a product to treat sexually transmitted infections (STIs). The funding would likely not go toward researching the sexual practices of teenagers, but rather toward researching STI antibiotics, which would help sell treatment drugs. Dr. Lexchin added:
The pharmaceutical industry level of resources means that other voices and other kinds of research may be drowned out.7
While medical schools maintain that drug industry funding helps to promote quality education, Dr. Lexchin believes that drug companies should not play any role in shaping what and how future physicians learn and says that medical schools are environments ripe for influence.6
Harvard Professor Says Relationship Between Big Pharma and Medical Schools is Increasingly Entangled
In 2000, Dr. Angell, in her position as a senior lecturer in Social Medicine at Harvard Medical School, asked, Is Academic Medicine for Sale?8 Dr. Angell described the evolution of the relationship between medical schools and the pharmaceutical industry, a relationship she said has only grown to be increasingly entangled and too intimate since the late 20th century. She cited a poll in which 94 percent of physicians surveyed acknowledged receiving financial compensation of some form from pharmaceutical companies.
Dr. Angell also cited the Bayh-Dole Act of 1980 in which Congress voted to allow universities to patent discoveries that stem from federally funded research, and then license those discoveries exclusively to companies in return for royalties. This 1980 Act created a financial incentive for universities to aim for discoveries that were likely to benefit the pharmaceutical industry, rather than the public at large. In her address, Dr. Angell stated:
Drug companies [do not] aim to educate doctors, except as a means to the primary end of selling drugs. Drug companies don’t have education budgets; they have marketing budgets from which their ostensibly educational activities are funded.8
She went on to outline reform steps that would need to be taken in order to restore integrity with the profession and stated the need for the profession to wean itself from industry money. Dr. Angell concluded:
You are not entitled to anything you want just because you’re very smart. Conflicts of interest in academic medicine have serious consequences, and it is time to stop making excuses for them.8
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1 Gallant A. A growing number of Americans report taking prescription medications daily. Civic Science Jan. 11, 2023.
2 Colino S. How much do doctors learn about nutrition? U.S. News and World Report Dec. 7, 2016.
3 Pharmaphorum. A history of the pharmaceutical industry. Sept. 1, 2020.
4 Schmidt E. How Rockefeller created the business of western medicine. Meridian Health Clinic Dec. 27, 2019.
5 Simpson JK. The five eras of Chiropractic & the future of chiropractic as seen through the eyes of a participant observer. Chiropractic & Manual Therapies Jan. 19, 2012.
6 Stahnisch F, Verhoef M. The Flexner Report of 1910 and Its Impact on Complementary and Alternative Medicine and Psychiatry in North America in the 20th Century. Evidence Based Complementary Alternative Medicine Dec. 26, 2012.
7 Hensley L. Big pharma pours millions into medical schools—here’s how it can impact education. Global News Aug. 12, 2019.
8 Angell M. Is academic medicine for sale? Boston Review June 26, 2012.