In the era of the post-war years when the subject of biochemistry was being built from its beginnings, scientists had considerable academic freedom and steady funding which was issued with an eye on the long term.  The advances made in science during the initial following decades form much of the bedrock of much modern medicine.

Things started to change in the 1970s with a sharply increased level of scrutiny on the outcomes of government funded projects, which was perhaps inevitable after the mass university building of the 1960s created a lot more competition for funding.  While it may well have reduced waste on frivolous projects, it also created drag on all research since those allocating the funds could not possibly have a sufficient understanding of the potential of grant requests.

Then in the 1980s there was a dramatic shift in the philosophy behind research with a drive for more commercial funding of science, which in the case of medical research meant an ever increasing reliance on the pharmaceutical industry.  By 2010, two thirds of medical research was funded commercially, a fraction which has only grown over the subsequent years. [102]  At the same time, academic institutions and researchers started to be allowed to sell patents on findings from government funded research, a change which was introduced so as to keep more talent in academia rather than industry, but introduced another influence into academic research.  There is an obvious divergence between the goal behind working to understand biological processes, and the mechanisms behind illness, leading ideally to its prevention or otherwise to its cure, and the goal of generating maximum revenue from drug sales.  One time president of Harvard University, Derek Bok, reflected in 2004: 'universities, faced with these temptations, are jeopardizing their fundamental mission in their eagerness to make money by agreeing to more and more compromises with basic academic values.' [314]

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Contracts between industry and academic hospitals for conducting clinical trials usually gave the industry funding body ownership of the trial data as 'commercial property', with the data then withheld from peer reviewers who only had access to summaries in the manuscripts submitted for publication.  Contracts also often allowed industry authors to 'ghostwrite' the trial reports, with the named authors only having a nominal role in the publication process. [313]  The industry would design the study and conduct the analysis, and then write up the results. [110]

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Meanwhile many clinical trials moved out of academia completely; in 1991 80% of industry funding for clinical trials went to teaching hospitals, whereas by 2004 the figure had fallen to 26%. [313]  Research contracted outside academic hospitals had even less independence. [315]

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Four decades of medical research ever increasingly motivated by financial return has proved extremely successful at the task with the pharmaceutical sales worth an estimated $603 billion in 2022 in the US alone. [122]  It is a backdrop against which it makes only too much sense that more than half of American children now have chronic illnesses requiring lifelong drug prescriptions.

There has long been evidence that research paid for by the industry is far more likely to promote drug sales than independent research. [103-111, 313-317]  Meanwhile the regulatory capture of both the CDC and FDA is well documented with both agencies now working in collaboration with the industry that they are supposed to be regulating.  In 1994 10% of the FDA drug budget stemmed from industry paid user fees, whereas by 2023 it had become more than two thirds.[112]  And to give just one example of how the same individuals can occupy senior positions in both industry and regulatory authorities, as head of the CDC Julie Gerberding fast-tracked the approval of the HPV vaccine made by Merck, and also supervised the cover up of evidence of harm being caused by the MMR vaccine made by Merck[113], and then left the CDC to become head of vaccines for Merck.[114,115]

There has been discussion of the problem in scientific circles.[116, 309]  Foundational research, purely for the sake of venturing into the frontiers of knowledge for its own sake, can only be conducted with public funding which is allocated without prior knowledge of potential applications, with a long term view to its eventual utility, and with the expectation that some wrong turns will be made.  Proposed solutions involve a lot more public funding being made available, although when compared to the money spent on medical treatment the sums involved are tiny.  Funding bodies should operate independently of each other with overlapping areas of responsibility so that any one body will not be dominant if it becomes overly imbued with a monocular view, or becomes corrupted by outside interests.  Finally, academic research must meet commercial research at a carefully controlled interface.  The ultimate goal is a funding structure of medical research which sees life destroying illness as a problem to be solved rather than a bonanza to be reaped.

At the same time, independent investigatory bodies must assess the harms being caused by modern environmental exposures rather than the investigation being conducted by the authorities that allowed the exposures in the first place.
 

Taking a step back

It is hard for anybody with a sense of human decency to reconcile with the sheer magnitude of the corruption of modern medicine.  That the single industry most devoted to human compassion, with an extremely highly qualified workforce, could have become so destructive seems unfathomable.  The facts are however clear for anybody who cares to look.

In the 1840s Dr. Ignaz Semmelweis demonstrated at a hospital in Vienna that by washing their hands with a lime and chlorine solution before presiding over childbirth, doctors could reduce mortality caused by fever (now known as sepsis) from 18.3% to 1.3%, and that washing medical instruments reduced the number of fevers still further.  Some doctors, mostly in Hungary, took the findings to heart and protected their patients, but the greater part of the medical establishment rejected the idea that doctors were harming their patients, with the majority of doctors continuing to let their patients die.  For a good number of years the mortality rate under the direction of Dr. Semmelweis in what is now Budapest was 0.85% while in Vienna and Prague it was 10 - 15%.  Dr. Semmelweis was ultimately sent to an asylum in 1865, where he died of sepsis.[117]  That same year the work of Louis Pasteur in France on the role of microbes in illness was taken onboard by the Scottish surgeon Joseph Lister, who demonstrated that cleaning surgical instruments with carbolic acid reduced infection and mortality following surgery dramatically.  It was only then that medicine as a whole finally started to change its procedures.

Technology has advanced over two centuries but human nature remains the same.

Future generations will study the early twenty first century, mystified as to just how, and why, so many scientists and doctors, along with political leaders and media, failed or refused to see what was happening right in front of them, and for so long.