By Justin Yamashita, MSc. Benchtop, site, CRO: three levels of basic and clinical research, explained without spin.

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The pharmaceutical industry earned its bad reputation. I’m going to prove it to you, name by name, with cases that are documented and not in dispute. Then I’m going to show you the one thing that list can't do.

If you've ever wanted the receipts on why people distrust pharma, this issue in particular hands them to you.

Issue 011 ended on a number and a tease. More than 90% of cancer patients never enroll in a clinical trial. Only about 7% ever take part. One reason is distrust of the system, and that distrust doesn't live in a vacuum. It lives next to something in the supplement aisle.

Before we get to the supplement aisle, we must take one issue and do the work that earns the right to make that argument. The industry has a bad reputation. Some of it's earned. This issue explains exactly how it was earned, and then asks the question the earned reputation can't answer on its own.

Without a return on investment, nobody funds the next drug. That isn't a defense of any company. It's a structural fact about how drug development gets financed.

In previous issues we’ve explored how the average drug that makes it through clinical trials took more than a decade and, by recent estimates, around a billion dollars or more to develop. Most drugs that enter Phase 1 never reach patients. The economics require that the drugs that do make it carry the cost of the ones that do not. A barrier and complication that Operation Warp Speed bypassed as described in Issue 002.

That's the starting condition. It doesn't excuse every behavior that follows from it. But 'profit exists' and 'the system is therefore corrupt' are different claims, and the gap between them is the whole issue.

Profit is the starting point, not the problem.

Martin Shkreli. In 2015, Turing Pharmaceuticals acquired daraprim (pyrimethamine), a 62-year-old drug for toxoplasmosis, and raised the price from $13.50 to $750 per tablet overnight. The drug was off-patent. There was no new clinical data. There was no new manufacturing investment. The increase was pure extraction.

The opioid crisis. Purdue Pharma and the Sackler family aggressively marketed OxyContin to primary care physicians using data that misrepresented the drug's addiction risk. Hundreds of thousands of deaths followed. Purdue pleaded guilty to criminal charges. This wasn't a system failure. It was a documented decision to misrepresent safety data in a marketing campaign.

Biosimilar delay. AbbVie's adalimumab (Humira) is one of the best-selling drugs in history. AbbVie filed more than 240 patent applications around the drug, most of them after it was already approved. US biosimilar competition was held off until 2023, roughly 5 years after biosimilars reached Europe. Patients paid more, or went without, for years while the legal strategy held.

Pay-for-delay. Brand-name manufacturers sometimes pay generic companies to stay off the market for years after the patent has expired. The arrangement keeps the cheaper generic out of reach while the brand keeps the profit. The FTC has documented this practice extensively.

Evergreening. Minor reformulations of an existing drug, a new salt form, an extended-release version, a new dosing regimen, can generate new patents that extend exclusivity past the original. The clinical benefit is sometimes minimal. The exclusivity extension is not.

Ghost-writing and selective publication. Companies have drafted clinical papers published under physician names. Studies with neutral or negative results have been held back while positive results were published. Both practices distort the information environment that physicians and patients depend on.

This list isn't exhaustive. Every item on it's documented. None of it represents the entire industry. That's the point.

The Philadelphia chromosome that eventually led to Gleevec was identified in 1960. That work was basic science in labs, publicly funded, with no pharmaceutical company involved. The link between the chromosome and CML was established over decades by researchers who had no stake in the commercial outcome.

The chain that produces a drug looks like this: Public funding supports basic research at universities. Those discoveries get licensed to biotech companies that take on the risk of clinical development. Pharmaceutical companies, sometimes by acquisition, bring the manufacturing and regulatory infrastructure. The FDA reviews the evidence. Patients get the drug.

Pull any section and the flow stops. The 'pharma did this' framing credits or blames one link for the output of all of them.

And every pipe in that pipeline is a clinical researcher, a person, not a logo. The 'pharma did this' framing erases the scientist who spent a career on one target, the clinical research coordinator who sat with a scared patient on consent day, the biostatistician who guards the numbers, and the reviewer who can say no, and sometimes does.

The companies responsible for drugs like Gleevec are also capable of the behaviors listed above. The pipeline argument doesn't erase the bad-actor list. The bad-actor list doesn't erase the pipeline. Both are true, so conflating them produces a picture less accurate than either alone. Instead, we need to hold two truths at the same time.

A purely profit-driven industry would not fund research in pancreatic cancer, long considered commercially unattractive: small population, short survival, narrow treatment window. Revolution Medicines spent years pursuing RAS-targeted therapy there anyway, and the bet paid off. The early daraxonrasib data we covered in Issue 008 has since been borne out: in a 2026 Phase 3 trial, daraxonrasib roughly doubled median survival compared with chemotherapy in previously treated metastatic pancreatic cancer, a disease where almost nothing has worked.

A purely profit-driven industry would not fund rare disease research, where the patient populations are by definition too small to generate blockbuster returns.

The math of 'pure profit' doesn't explain those bets. Something else is in the system. A mix of scientists who chose this work for what it can do, regulatory incentives for orphan drug development, and commercial logic messier than a single motive. I’ve sat in the Zoom meetings, the Teams meetings, the conference rooms with the people pouring their hearts and minds into making these clinical trials work because they care. People who were inspired by a father that died of cancer, or a loved one with Multiple Sclerosis, or who are passionate about better options for diabetes patients. I’ve seen my teams working on weekends to answer regulatory agency questions to keep study timelines on track. I’ve seen family time sacrificed to address an urgent site need after hours for a site in another time zone. “Pure profit” doesn’t explain why those people go the extra mile constantly when the going gets tough.

There's even an entire organization built on the opposite of the profit motive. The Drugs for Neglected Diseases initiative, DNDi, is a non-profit that develops treatments for the diseases the market ignores, like sleeping sickness and Chagas, the illnesses of the world's poorest people. It runs on public and philanthropic money, partners with drug companies for the manufacturing, and keeps prices low on purpose. Since 2003 it's delivered more than a dozen new treatments, including the first treatment for sleeping sickness you can take entirely by mouth. That disease was long treated with an arsenic-based drug so toxic it killed some of the patients it was meant to save. No blockbuster. No patent windfall. Just the work. If profit were the only thing in this system, DNDi couldn't exist. It does.

This myth does two things at once. First, it's right about profit. Second, it draws a conclusion from that truth that doesn't follow.

That profit exists is accurate. That profit therefore makes the clinical trial process untrustworthy needs one more step. It needs to show how profit changes the outcome of independent FDA review, independent data safety monitoring boards, independent advisory committees, and post-marketing surveillance. That’s the step where the argument breaks down.

Gleevec is useful here because both stories are visible in it. Gleevec was developed by Novartis, which also builds patent portfolios to protect revenue. Both true. The IRIS trial data, the FDA review, and the advisory committee vote were not controlled by Novartis's commercial interests. The safeguards exist because those interests are real. Knowing about the safeguards requires knowing about the interests.

Apply it to the 'pharma is all about profit' claim. Who benefits if it's believed without nuance? Supplement companies, alternative health platforms, and wellness brands compete with regulated pharmaceuticals. Part of their business model is funded by eroded trust in the regulated system. That doesn't make the criticism of pharma wrong. It makes the source worth examining alongside the argument.

The behaviors above are documented and condemnable. Is the same documentation standard applied when the alternative is chosen? If a pharmaceutical company's practices disqualify it from trust, what practices disqualify a supplement company from the same trust?

FILL THE GAP   Someone will send you a scary 'pharma lies' claim this week. The free Skeptic's Toolkit (https://shop.roottorx.com/products/a-skeptics-toolkit-10-questions-for-any-claim) is the exact 10 questions Debby the Denier in Recovery runs on it in the Root Room, the same claims in this section. Grab it free in the Field Guide at roottorx.com so you’re ready before the next link lands in your news feed.

We just spent an issue naming what pharma gets wrong. Next week: the industry that skipped a lot of those steps with the same financial motive, with no clinical trials required. We walk into the supplement aisle.

This one is harder to share than most. It defends a system while naming exactly how that system fails, and the people in your life who most need it are the hardest to send it to. Send it anyway. Forward this to the one person who keeps telling you they can't trust anything big pharma makes. Not to win. To hand them the receipts and the context at the same time.

Then reply with one line: what did this issue change for you, and what are you still holding? Every reply shapes the next issue, and the readers who go looking for the flaw before they share are part of the #SkepticalRevolution.

Also: read The Root Room and The Informed on the web. New here? Start with Issue 003b (the Skeptic's Toolkit), Issue 001 (why your distrust is rational), and Issue 004 (how a drug gets built and approved).

Citations verified June 2026 where noted.

[1] Daraprim price increase, 2015 (about $13.50 to $750 per tablet), Turing Pharmaceuticals: contemporaneous reporting, The New York Times, September 2015.

[2] Purdue Pharma and OxyContin marketing, misrepresentation of addiction risk, and guilty pleas: US Department of Justice; court filings.

[3] AbbVie / Humira: more than 240 US patent applications, about 89% filed after FDA approval; US biosimilar competition delayed to 2023, roughly 5 years after Europe (October 2018). I-MAK, 2018.

[4] Pay-for-delay / reverse-payment settlements: US Federal Trade Commission reports; FTC v. Actavis, 570 U.S. 136 (2013).

[5] Public funding underlies the pipeline: Galkina Cleary E, et al. Contribution of NIH funding to new drug approvals 2010-2016. Proc Natl Acad Sci USA. 2018;115(10):2329-2334. https://doi.org/10.1073/pnas.1715368115 (NIH funding contributed to every one of the 210 drugs approved 2010-2016).

[6] Drug development cost: Wouters OJ, McKee M, Luyten J. Estimated research and development investment needed to bring a new medicine to market, 2009-2018. JAMA. 2020;323(9):844-853. https://doi.org/10.1001/jama.2020.1166 (median about $985 million, mean about $1.3 billion, counting failed trials). Older industry figures near $2.6 billion (DiMasi et al., J Health Econ 2016) are contested.

[7] Daraxonrasib Phase 3 in pancreatic cancer: O'Reilly EM, et al. Daraxonrasib or chemotherapy in previously treated metastatic pancreatic cancer. N Engl J Med. 2026. https://doi.org/10.1056/NEJMoa2605555 (median overall survival 13.2 vs 6.6 months; hazard ratio 0.40).

[8] Drugs for Neglected Diseases initiative (DNDi): non-profit R&D model; 14 new treatments delivered since 2003 (goal 25 by 2028); diseases include sleeping sickness, Chagas, leishmaniasis. dndi.org (figures per DNDi, 2025).

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