Big Pharma, doctors, and why treating symptoms is the best business model

At about 11, I was diagnosed with psoriasis and told I’d need about $30,000 a year in medication for life. Nobody asked how I ate, slept, or handled stress. My mom and I changed how I ate, slept, and recovered, and my skin cleared in about three months.

Cures can shrink a drug market

A 2018 Goldman Sachs report for biotech investors asked, “Is curing patients a sustainable business model?” It cited Gilead’s hepatitis C drugs, which cure most patients. Sales peaked at about $12.5 billion in 2015, then fell sharply as cured patients stopped buying and fewer new patients remained. Treatments people take for decades don’t have that problem.

Follow the money

• U.S. health spending was $4.9 trillion in 2023, about 17.6% of the economy. Retail prescription drugs alone were about $450 billion.
• About 90% of that spending goes to people with chronic and mental health conditions, according to the CDC.
• From 2000 to 2018, large drug companies had a median profit margin of 13.8%, compared with 7.7% for other large S&P 500 companies.
• U.S. prescription drug prices were about 2.8 times those in 33 other wealthy countries, and over 3 times for brand-name drugs (RAND, 2024).
• Nearly half of Americans took a prescription drug in the past month. About 1 in 8 took five or more.

The best customer is a customer for life

The ideal business sells a subscription people can’t easily quit. In medicine, that’s a daily pill or injection for a chronic condition like high blood pressure, acid reflux, depression, or psoriasis, often taken for life.

Many of these drugs work and prevent real harm. But the system has much stronger incentives to sell management than to fix causes. Nobody gets paid when you sleep better or eat real food.

Drug marketing targets you and your doctor

Only the U.S. and New Zealand allow prescription drug ads aimed at consumers. From 1997 to 2016, U.S. medical marketing grew from $17.7 billion to $29.9 billion, and consumer ads from $2.1 billion to $9.6 billion. More than $20 billion of the 2016 total targeted doctors and other health professionals through sales visits, free samples, sponsored talks, and meals. In a study of hundreds of thousands of U.S. doctors, even one sponsored meal, averaging under $20, was linked to more prescriptions of the promoted brand-name drug. Most doctors believe they aren’t influenced.

The system pushes doctors toward prescriptions

• Fee-for-service pay: much of U.S. medicine pays for each visit, test, and procedure, not for whether you get better.
• Short visits: the average primary care visit is about 18 minutes, too short to discuss sleep, food, and stress. Shorter visits are linked to more inappropriate prescribing.
• Little nutrition training: in a national survey, U.S. medical schools averaged under 20 hours of nutrition education, below the recommended 25.
• Drug-focused research: companies fund big trials for profitable drugs. Nobody owns sleep, sunlight, or vegetables, so they’re studied far less.

Most doctors want to help, but this system excels at emergencies, surgery, and infections and is much weaker at the daily drivers of chronic disease.

The industry outspends all others on lobbying

According to OpenSecrets, the pharmaceutical and health products industry consistently spends more on federal lobbying than any other industry. That money shapes drug pricing rules, patents, and insurance coverage, and is one reason prices stay high and prevention gets little attention.

Lifestyle can rival drugs

In the Diabetes Prevention Program, high-risk adults who changed their diet and exercised about 150 minutes a week cut their risk of type 2 diabetes by 58%. The drug metformin cut it by 31%. The system rarely builds care around lifestyle results like that, because there’s nothing to sell.

Modern medicine still saves lives

Antibiotics, vaccines, insulin, surgery, emergency care, and modern biologics for severe psoriasis have saved and changed millions of lives. Some conditions need medication no matter how well you live. Use medicine for what it does best, and own the daily basics no prescription can replace.

How to be a smarter patient

• Ask what’s causing the problem, not only what treats it.
• Ask whether changes in food, sleep, movement, or stress could help, and how long to try them.
• Ask whether the drug is for life, and what would need to change to reduce or stop it safely.
• Ask for the number needed to treat: how many people like you must take the drug for one to benefit. It’s often higher than expected.
• Ask about generics. They have the same active ingredient and often cost far less.
• Look up industry payments to U.S. doctors in the federal Open Payments database.
• Get a second opinion for big decisions or lifelong treatments.
• Change medication only with your clinician, and never stop a medication suddenly. Blood pressure medicines, antidepressants, steroids, and some other drugs can be dangerous to stop abruptly.

Bring your own data

Track sleep, food, stress, and symptoms, and you’ll bring weeks of patterns to an 18-minute visit instead of a vague memory. The visit can then focus on causes, not refills. A short daily check-in is the easiest way to start.