In 2021, philosopher of science Sergio Sismondo argued that the pharmaceutical industry doesn't merely influence medical science but epistemically corrupts it by co-opting the trust placed in medical research. Here's how.
Big Pharma Exploits the Knowledge System
What is a Knowledge System?
A knowledge system is the social, institutional, and methodological infrastructure a society uses to produce, validate, organise, and distribute knowledge. In medicine, the knowledge system is the entire framework that transforms uncertainty about treatments, diseases, and outcomes into trusted guidance for clinicians and patients.
In short, the knowledge system exists to help clinicians make decisions that protect and improve patient health. Which is why the knowledge system carries an extraordinary level of trust — it is assumed to exist solely to safeguard patient health.
Leveraging the Knowledge System
The pharmaceutical industry recognises the trust built into medical science and exploits it by inserting itself at the earliest stages of research. By influencing the design, execution, and publication of studies, it shapes the evidence long before it reaches clinicians. What the public eventually sees retains the appearance of independent science, even though its conclusions have been quietly aligned with corporate interests.
This exploitation occurs in a few ways.
Funding Leads to Favourable Outcomes
Sismondo's work makes one point unmistakably clear: funding shapes outcomes. When pharmaceutical companies sponsor clinical research, the results and conclusions are statistically more likely to benefit the sponsor. The Cochrane Review he relies on illustrates this in two key findings:
- Industry-funded drug and device trials tend to report stronger efficacy and more positive conclusions than independent studies.
- Trials without industry involvement are twice as likely to identify safety issues and report harms.
An earlier study also reported an odds ratio of 3.60 for favourable outcomes in industry-funded trials — meaning sponsorship made positive results more than three times as likely.
Influencing Doctors to Prescribe Medications
Although it may seem unethical, financial relationships between pharmaceutical companies and prescribing doctors are incredibly common. These payments take many forms — cash transfers, speaking fees, consulting arrangements, "educational" travel, and seats on advisory boards.
One of the most widely cited reviews on this issue, published in Annals of Internal Medicine, examined 36 studies and 101 separate analyses. It found that in 89 of 101 cases, doctors who received industry payments prescribed more drugs from the paying company, had higher overall prescribing costs, and a greater use of branded medications.
Pharmaceutical Companies Control Their Own Research
When a pharmaceutical company sponsors a clinical trial, it rarely acts as a passive funder. In most cases, the company controls the trial itself — from the study design and data analysis to the writing and publication of the final article. This happens because the bulk of the work is outsourced to Contract Research Organisations (CROs). An estimated 70-75% of pharma's clinical trial spending flows to CROs rather than independent academics, giving companies direct authority over how studies are conducted and communicated. In practice, this means:
- The company chooses the hypotheses and endpoints
- The company controls the data
- The company decides what gets published
- The company shapes the interpretation and narrative
- Academics often appear as authors but function primarily as credentialed validators rather than true investigators.
The result is predictable: the final publications still look like neutral, peer-reviewed science, but the conclusions are subtly — and often substantially — tilted toward the sponsor's commercial interests.
Sismondo calls this system ghost-management: research that carries the appearance and authority of independent academic work but is, in reality, corporate science dressed in the uniform of medical scholarship. Through this structure, pharmaceutical companies gain countless opportunities to engineer favourable outcomes long before a study ever reaches a journal.
Downstream Consequences: How Corrupted Evidence Shapes Modern Medicine
Once pharmaceutical companies shape the evidence upstream, the effects cascade through the entire medical system. Corrupted research doesn't stay in journals — it becomes the foundation of how clinicians are educated, trained, certified, and instructed to practice. Effectively, in a system governed by medical literature, whoever shapes the literature shapes the practice of medicine.
1. Education: Corrupted Evidence Becomes the Curriculum
Medical students and trainees learn medicine through published research and literature. When that literature is engineered by industry, it reshapes their understanding of disease from the very beginning: drug-centric treatment becomes the norm, pharmaceuticals are taught as the default first-line intervention, and non-pharmacological approaches are pushed to the periphery. Corrupted evidence becomes the intellectual blueprint for how future clinicians think.
2. Continuing Professional Development: Reinforcing the Bias
Practising doctors, pharmacists, and other healthcare professionals must complete ongoing education to remain registered. These programs rely heavily on the same body of published research — meaning that if the evidence base is biased, mandatory professional development quietly reinforces that bias.
3. Guidelines: Biased Evidence Becomes Mandatory Practice
Clinical guidelines translate medical research into rules and standards that clinicians are expected — and sometimes legally required — to follow. When guidelines are built on corrupted evidence, they codify industry-shaped conclusions into mandatory practice. Medicine becomes drug-dependent not because pharmaceuticals are always the best option, but because the system itself is anchored to evidence produced by those who profit from pharmaceutical answers.
This is How Big Pharma Exploits the Knowledge System
Ultimately, the pharmaceutical industry trades on the presumed innocence of medical research's fundamental mission: to create knowledge that protects and improves patient health. By exploiting the immense trust built into the knowledge system, it redirects that system toward commercial ends. What appears to be neutral science is, in many cases, corporate strategy disguised as medical truth.
