Views & Reviews From the Frontline

Big pharma and big medicine in big trouble

BMJ 2013; 347 doi: (Published 15 November 2013) Cite this as: BMJ 2013;347:f6900
  1. Des Spence, general practitioner, Glasgow
  1. destwo{at}

Peter Gøtzsche, chief of the Nordic Cochrane Center in Copenhagen, is a tough guy, happy to push over the apple cart of perceived wisdom right in front of the vendors, wearing an expression that seems to cry out, “Come and get me if you think you’re hard enough.” Like a Nordic police investigator, in his new book Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare he systematically sets out the case against the drug industry.

It’s a classic courtroom drama, with lies and corruption on a truly global scale. The drug industry slits the throat of health and watches on as society bleeds. I want to slam down my hand, shouting, “I rest my case, your honour,” clap the drug industry in irons, and send it down. But the industry is let off, gives the finger, and strolls off to a waiting limo. It is acquitted because it hasn’t broken the law. So the counterfeit research printing presses will keep rolling, representatives will keep on selling pills, money will keep on sloshing, and champagne corks will keep on popping.

The medicine industry should be in the dock too. Why have we allowed the medicalisation of normality and the march of overdiagnosis and overtreatment? Of course the drug industry and big medicine have mutual financial conflicts of interest in making us sick. But there is another problem. We have followed guidelines and done as we were told even when we knew we shouldn’t have trusted our presumed and so called betters. Our professional deference conditions us to accept hierarchy.

Deference is about obedience, conformity, and demanding respect. But deference is unintelligent, complacent, conceited, and a poison to free thought and innovation. The weapons of deference are titles, awards, gongs, white coats, pinstriped suits, the arts, the thesaurus, schooling, qualifications, prestigious institutions, publications, accent, manners, and mannerisms. We have an untouchable and detached international elite of networking medical so called “experts” and unethical corporations. Deference means the voices of the many are drowned out by the voices of these few. Deference is the authoritarian instrument of intellectual oppression and stops us asking why.

But status and position should not matter. The great unwashed nobodies, we ordinary consultants and general practitioners, need to question, challenge, and refuse to cooperate. Tear down the orthodoxy, and deliver suffrage: a professional intellectual democracy. We don’t have any betters. All our opinions count. Respect certainly; deference certainly not. The case against deference is open and shut.


Cite this as: BMJ 2013;347:f6900


  • Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

  • Follow Des Spence on Twitter @des_spence1

View Abstract

Sign in

Log in through your institution