It’s no secret that drug research and development is commercialized. “Technology transfer” and for-profit partnerships have turned some medical centers, universities, and National Institutes of Health research itself into for-profit pipelines for the drug industry.
In 2007, Northwestern University, for example, made $700 million by selling part of its worldwide royalty interest in the anti-seizure medicine Lyrica, which its chemists developed. Pfizer, which sold the drug, paid massive commercial royalties back to Northwestern. According to Northwestern, the windfall capped a nearly 15-year process from invention to market launch in 2005.
Where do patients and their health care costs fit in? Many charge these partnerships do less to advance knowledge and public health than they do to enrich industry.
“In addition to distorting the research agenda, there is overwhelming evidence that drug-company influence biases the research itself,” wrote Marcia Angell, MD, former editor of the New England Journal of Medicine, noting that academic researchers are enlisted to “carry out studies for almost entirely commercial purposes.”
Real physician voices, twice a week
Free, and one click to unsubscribe.
Clinical trials have also been commercialized, which brings us to discussion of the very underreported role of contract research organizations (CROs) in drug development. Whereas human drug testing was once linked to, and protected by, medical or academic institutions, it has become a for-profit industry run by drugmaker adjuncts called CROs.
CROs package all the components of the clinical testing “game,” providing drugmakers services from trial design, subject recruitment, enrollment and consent administration, regulatory compliance assistance, and preparation of final submission-for-approval packages to the Food and Drug Administration (FDA). CROs will even do marketing and branding of new drugs. The largest CROs operate around the world, with tens of thousands of employees and billions of dollars in annual revenue.
Why do so few in the health field know this? By relieving drugmakers of the costs and liabilities of years of drug development, and the staff to conduct it, CROs might be the industry’s best-kept secret; when fraud questions arise, they are brought by whistleblowers to agencies like the FDA and Department of Justice and seldom covered by mainstream media.
Recently, a former employee of one large CRO claimed in a lawsuit that the company manipulated data on a clinical trial for an asthma drug to produce results that favored the pharmaceutical sponsor. A federal judge dismissed the suit in 2025 without ruling on whether that claim was true.
Earlier trial problems
In 2009, I reported on problems at a clinical trial facility in which subjects with abnormal EKGs and other exclusionary risks for the drugs being tested, like coronary artery disease, arrhythmia, pulmonary embolism, and rheumatic fever histories, were nonetheless enrolled in trials.
Seven years later, whistleblowing salespeople told me they were instructed by the makers of an asthma drug to market it beyond its FDA approval. A year before my report, a judge tossed out the main whistleblower complaint, citing a lack of particulars that would amount to actual violations of the False Claims Act. For asthma, the FDA had approved the drug only for moderate to severe persistent disease in patients 12 and older whose symptoms were not adequately controlled on inhaled corticosteroids. Clinical trials of the drug also showed a possible signal for malignancies.
Despite the drug’s indications and safety profile, the salespeople said, reps were told to assure doctors that a two-hour wait to monitor for anaphylaxis was unnecessary and that patients in some cases could self-administer the drug at home. Worse, they said, reps were even told to call on pediatricians and claim the drug was safe for children under 12.
Reps were also told to show doctors “studies,” compiled by doctors the companies had paid, that suggested non-FDA uses of the drug. One suggestion was using “rush immunotherapy,” accelerated exposure of patients to their allergen via injection to shorten treatment, simultaneously with the drug. But rush immunotherapy is also linked to anaphylaxis, putting patients at double risk.
Conclusion
Such shocking marketing may not stay in the hands of reps; drugmakers are now adding AI agents to their sales work. Sadly, my report on that marketing got little attention.
Martha Rosenberg is an investigative reporter whose work has appeared in the British Medical Journal (BMJ), Consumer Reports, Public Citizen, the Center for Health Journalism at USC Annenberg, the Nieman Foundation for Journalism at Harvard University, and other outlets. She studied at Rush Medical School and writes on health care, food, medicine, and public policy.
Rosenberg’s reporting has been cited by Memorial Sloan Kettering Cancer Center, Mayo Clinic Proceedings, Public Library of Science Biology, ScienceDirect, the Journal of Pain & Palliative Care Pharmacotherapy, the Journal of Trauma & Dissociation, Britannica, National Geographic, Hastings Law Journal, and Wikipedia. She is the author of several books, including Multidisciplinary Management of Chronic Pain: A Practical Guide for Clinicians, Born With a Junk Food Deficiency, Big Food, Big Pharma, Big Lies, and Food, Clothes, Men, Gas and Other Problems. She publishes on Substack, OpEdNews, and her Amazon author page.
