Xavier Azalbert, France-Soir
Pharmaceutical delinquency under the scalpel of Laurent Mucchielli: a damning analysis. Will the lessons be learned?
In his article published in March 2025 in Les Cahiers du CEDIMES, Laurent Mucchielli, sociologist and crime specialist, delivers a hard-hitting synthesis of the delinquency of the pharmaceutical industries and its devastating impacts on public health. Drawing on French and American sources, he paints a bleak picture of a system where the quest for profit takes precedence over ethics, science and human life. Here are the highlights of his analysis, the lessons to be learned, a comparison with other industries, and a perspective with current events.
Analysis of the main elements
It is above all a story of health scandals. Mucchielli traces a litany of pharmaceutical disasters since the 1950s: Stalinon (1953, France, 100 deaths), Thalidomide (1961, birth defects), Distilbene (1970s, cancers and infertility), Depakine (Sanofi, cognitive disorders), Vioxx (Merck, 30,000 deaths in the United States), Mediator (Servier, 1,800 deaths), OxyContin (Purdue Pharma, 310,000 deaths in the United States) and Levothyrox (Merck, 31,000 adverse reactions). These cases, far from being anomalies, reveal a systemic pattern of endangering the population.
The mechanisms of fraud and corruption deciphered. Mucchielli details the tactics of the manufacturers: falsifications of clinical trials (selection of biased samples, non-publication of unfavorable results, ghostwriting), including aggressive marketing whose interests are aligned with the benefit of the manufacturer and not that of the patient (bonuses to salespeople, gifts to doctors), up to and including institutional corruption (financing of electoral campaigns, influence peddling). The example of Purdue Pharma with OxyContin illustrates this well-oiled machine: false promotion of an opioid presented as not very addictive, despite evidence to the contrary known as early as 1995.
Rules and regulations with variable geometry, illustrated by conflicts of interest and revolving doors. Mucchielli highlights the role of "experts" with double hats, oscillating between public agencies (ANSM, FDA, EMA) and private industries. The "revolving doors" – such as Emer Cooke, who went from AstraZeneca to the head of the EMA – embody this collusion, where regulators become accomplices of the manufacturers they should control.
A marked deficiency in pharmacovigilance. The post-marketing surveillance system is structurally inefficient: more than 90% of adverse effects are not reported, and underfunded health agencies depend on biased data from manufacturers. In France, 20,000 annual hospital deaths are related to medications, according to Prescrire (2011).
The cost of sanctions is integrated into the economic model. Despite colossal fines (8.34 billion for Purdue Pharma, 9 million for Servier), these penalties are absorbed as an operating cost. With a global turnover of $1,600 billion in 2023, the industry remains flourishing, paying out record dividends (1,019 billion between 1999 and 2017).
Lessons for policymakers
A first observation: white-collar crime is underestimated. Echoing Edwin Sutherland (1939), Mucchielli shows that the delinquency of the economic elites, although more destructive than that of the poor, largely escapes the criminal justice system, which is masked by administrative sanctions.
A systemic bias with a system oriented towards profit, not health : the industry does not seek to treat, but to maximize its gains, at the cost of human lives. New drugs, which are often useless (90% without therapeutic progress according to Prescrire), serve shareholders above all.
Despite the many regulations, regulation is ineffective : post-scandal reforms (the 2011 law in France after the Mediator) are cosmetic "reforms", incapable of breaking public-private connivance or strengthening pharmacovigilance.
A willful blindness that leads to collective responsibility : the blindness of politicians, the media and the public – often hypnotized by the myth of "safe medicines" – perpetuates this impunity.
An industry that produces patients
Beyond organized crime, the pharmaceutical industry often acts against the fundamental interests of patients' health, transforming medicine into a market in which disease becomes a lucrative opportunity.
Historically, healthcare has never been an intrinsically profitable activity: before the rise of "Big Pharma", healthcare was based on local or public practices, which were not very monetised. Faced with this reality, manufacturers have changed their paradigm by developing a perverse strategy: manufacturing patients.
This involves the excessive medicalization of benign conditions (such as cholesterol or mild anxiety), the promotion of unnecessary treatments – 90% of new drugs do not bring any therapeutic progress according to Prescrire (2023) – or the creation of addictions, as with OxyContin, whose aggressive promotion has turned patients into addicts. This logic, where health becomes a pretext for consumption rather than an objective, is radically opposed to the original medical ethics, illustrating a system that thrives on vulnerability rather than well-being.
Comparison with other industries
The delinquency of the pharmaceutical industry shares striking similarities with that of other sectors, notably finance and polluting industries, both in its systemic nature and in the relative impunity it enjoys.
In finance, the subprime crisis of 2008 revealed massive fraudulent practices (toxic loans, opaque securitization), leading to record fines – such as the $8.9 billion paid by BNP Paribas in 2014 for violating US embargoes – but without any real structural reforms, with the remaining bankers' bonuses intact. Polluting industries, such as oil or chemicals, illustrate another facet: despite the "polluter pays" law (adopted in France in 1995), sanctions, such as the $5 billion imposed on BP after the 2010 oil spill, are often absorbed as an operating cost, without curbing global emissions.
Conversely, the pharmaceutical industry stands out for its direct impact on human life, where fines (8.34 billion for Purdue Pharma) coexist with political inaction in the face of "revolving doors" and failing pharmacovigilance. While finance has seen regulations such as Dodd-Frank (2010) in the United States quickly circumvented, and polluters often symbolic climate commitments, the pharmaceutical industry is still escaping a profound questioning, its colossal profits (1,600 billion in 2023) taking precedence over ethics, as in these other sectors where profitability prevails over responsibility. Health is like pollution, subject to an asymmetry of information between the patient and the industrialist. It is therefore easier for him to play on psychological lifts such as the fear of the disease rather than working on prevention. The same goes for finance when bank managers are not able to understand the commitments of their operators on the financial markets that lead to abuses such as the fall of Barings or the Kerviel affair with Société Générale. The greedy quest for profits is also a cause of willful blindness.
Analysis in relation to current events (March 2025)
In light of the news as of March 25, 2025, Mucchielli's analysis resonates with particular acuity. The Covid-19 crisis, still fresh in people's memories, has exacerbated tensions around vaccines (AstraZeneca vaccines withdrawn for side effects) and treatments (hydroxychloroquine demonstrating its effectiveness in many studies but never enough for regulators). The accusations of corruption and scientific bias, evoked by Mucchielli in the "Lancet Gate" (2020), find an echo in the current debates on the transparency of vaccine data and opaque contracts between governments and laboratories such as Pfizer. In addition, the rise of populist discourse in Europe and the United States, fuelled by mistrust of the elites, now includes "Big Pharma" as a privileged target. The recent revelations about political financing ($4.7 billion in the United States between 1999 and 2018) could amplify this mistrust, especially if media investigations, such as those on Servier in 2022, continue to emerge. Finally, the climate crisis and calls to regulate multinationals could push lawmakers to tighten controls, although Mucchielli doubts their effectiveness without a systemic overhaul.
Yesterday, the U.S. Senate approved the nomination of Dr. Jay Bhattacharya as Director of the U.S. NIH by 53 votes to 47 against. Bhattacharya, a professor of economics and medicine at Stanford University, convinced the senators that his ambitious plan to reform the system of scientific production, with one of the largest research budgets in the world, is realistic. France-Soir remains the only French media to have interviewed Bhattacharya several times ( here, here, and here). Mucchielli, like many other scientists, will closely observe how Bhattacharya goes about achieving his goals, which boil down to restoring science to its former glory.
Will Bhattacharya read Mucchielli's implacable indictment of an industry that, under the guise of science, sacrifices public health to capitalist logic? It calls for collective awareness and radical reform: real transparency, independence of experts, robust pharmacovigilance and dissuasive sanctions.
In 2025, when scandals are repeated and trust erodes, his message is clear: without a political and citizen jolt, this "delinquent system" will continue to prosper, to the detriment of millions of lives.