When a drug company commits a serious crime, the standard response from the industry is that there are bad apples in any enterprise. Sure, but the interesting question is whether drug companies routinely break the law.

I googled the names of the 10 largest drug companies in combination with the term “fraud” and looked for offences on the first page for each company. The most common recent crimes were illegal marketing by recommending drugs for non-approved (off label) uses, misrepresentation of research results, hiding data on harms, and Medicaid and Medicare fraud.1 All cases were related to the United States and involved huge settlements or fines, exceeding $1bn (£620.6m; €769m) each for four companies.

It was easy to find additional crimes committed by these same companies and committed outside the US.1 As the crimes were widespread and repetitive, they are probably committed deliberately—because crime pays. Pfizer, for example, agreed in 2009 to pay $430m to resolve charges related to illegal marketing of gabapentin (Neurontin), but as sales were $2.7bn in 2003 alone, and as about 90% was for off label use, such …