The term “Big Pharma” is used quite often to describe massive pharmaceutical companies that make literally billions of dollars every year to keep Americans regularly supplied with a medicine cabinet’s worth of pills. But when we say Big Pharma, who are the players in the pharmaceutical industry? Who is responsible for flooding neighborhoods and communities with addictive medication? Who are the agencies responsible for keeping them in check? How are other countries dealing with addiction treatment?

The Money of Medicine

There are two sides to the coin of this conversation: the pharmaceutical industry, which is responsible for the development, manufacturing, and marketing of drugs for use as medications; and Big Pharma, the colloquial (and often pejorative) term used to describe faceless corporations that push hugely overpriced drugs onto hapless and desperate consumers.

Some of the names of the biggest players in the industry may be familiar. Others may not ring as many bells, but with their market value, the relative anonymity works to their advantage. The Motley Fool provides a list of the companies doing the best business:

• Johnson & Johnson ($276 billion market value)
• Novartis ($273 billion)
• Pfizer ($212 billion)
• Merck ($164 billion)
• GlaxoSmithKline ($103 billion)
• Eli Lilly ($98 billion)

Those deep pockets allow pharmaceutical companies to spend astronomical amounts on advertising. In 2014, spending on advertising was worth $4.53 billion, representing an 18 percent year-by-year increase. Out of all the individual companies in the industry, Pfizer spent $1.4 billion on advertising. Eli Lilly, the company behind the erectile dysfunction medication Cialis, spent $272 promoting that drug alone.

The highest amount paid in a single year on marketing pharmaceutical products was $5.4 billion in 2006. Ten years later, an ad aired during that year’s Super Bowl that was 60 seconds long and cost $10 million to produce but reached 111 million viewers.² The BMJ Journal writes that drug companies spend 19 times more on marketing than they do on research and development.³

That’s a lot of money to spend on advertising, but io9 writes that every $1 spent on a commercial, billboard, radio, or print ad, brings over $4 in retail sales. For example, Boehringer Ingelheim spent $464 million in advertising for Pradaxa, its blood thinner, in 2011. In 2011, sales of Pradaxa passed $1 billion

Marketing Medicine

The investment is a sound one: Doctors prescribe new drugs that are featured in direct-to-consumer advertising nine times more than drugs that are not marketed publicly. This is because patients sometimes demand to be given the drugs they’ve seen in commercials (or heard about from their friends and family members), but also because some doctors receive handsome bonuses for promoting medications from certain manufacturers

The Wall Street Journal created an interactive graphic that showed how companies rewarded doctors – and by how much – in just the four months between August and December 2013:

• Promotional talks and honoraria: $228.1 million
• Travel, lodging, and entertainment: $95.9 million
• Food and drinks: $92.8 million

One of the results of this spending avalanche is that pharmaceutical companies are seen and heard everywhere in the public sphere. “It’s true,” writes the Washington Post, “drug companies are bombarding your TV with more ads than ever.” Thanks to federal rules allowing drug companies to advertise directly to consumers, and an economic recovery after the Great Recession, pharmaceutical corporations have enjoyed their time in the sun. In 2014, television accounted for 61.6 percent of companies’ direct-to-consumer advertising revenue

With so much money at stake, it comes as no surprise that pharmaceutical companies are behind some of the biggest mergers and acquisitions in history. Pfizer purchased Warner-Lambert for $87.3 billion in 1993 (adjusting for inflation, about $125 billion in 2016). Pfizer’s goal was to have sole marketing leverage over the drug Lipitor, a medication to lower cholesterol. Crain’s New York Businesscalled Lipitor “the best-selling drug in the history of pharmaceuticals,” after the medication generated revenue of $1 billion in its first year and went on to produce $125 billion worth of sales in almost 15 years.⁸ The pharmaceutical industry has some very deep pockets; across the entire world, the medication market was worth $1 trillion in 2014, and a quarter of that revenue came from the United States alone, where five of the top 10 pharmaceutical manufacturing companies are located.