The title is fromPeter Rost's book published in 2006, The Whistleblower. He is a former executive at Pfizer and one of the few Big Pharma leaders to speak out against the industry. In one revealing passage from the book this is what he said:
"It is scary how many similarities there are between this industry and the mob. The mob makes obscene amounts of money, as does this industry. The side effects of organized crime are killings and deaths, and the side effects are the same in this industry. The mob bribes politicians and others, and so does the drug industry … The difference is, all these people in the drug industry look upon themselves – well, I'd say 99 percent, anyway – look upon themselves as law-abiding citizens, not as citizens who would ever rob a bank … However, when they get together as a group and manage these corporations, something seems to happen … to otherwise good citizens when they are part of a corporation. It's almost like when you have war atrocities; people do things they don't think they're capable of. When you're in a group, people can do things they otherwise wouldn't, because the group can validate what you're doing as okay.
Peter Rost offers a rare insider's perspective on the pharmaceutical industry from his time as a former Pfizer executive. His explosive comparison of Big Pharma to organised crime, as captured in the passage above, sets the stage for a damning critique: an industry that mirrors the mob not just in its pursuit of profit, but in its methods, lack of ethics, and societal impact. Building on Rost's argument, the similarities between Big Pharma and the mafia are striking—both in their operational tactics and their ability to cloak themselves in legitimacy while leaving a trail of harm.
Rost's core assertion is that the pharmaceutical industry, like the mob, thrives on obscene wealth generation. In 2023 alone, the global pharmaceutical market raked in over $1.5 trillion, with giants like Pfizer, Roche, and Johnson & Johnson pocketing billions in profits. This mirrors the mob's racketeering empires, where money flows from exploitation—whether it's drugs, protection rackets, or, in Big Pharma's case, "life-saving" medications priced out of reach for many. Consider insulin, a drug discovered a century ago, yet today, its price in the U.S. can exceed $300 per vial, a markup driven not by production costs but by corporate greed. Like the mob extorting vulnerable communities, Big Pharma squeezes patients who have no choice but to pay or perish.
The parallel extends to the "side effects" Rost highlights: death and suffering. While the mob's violence is overt—hits, turf wars, executions—Big Pharma's toll is subtler but no less lethal. Take the opioid crisis: companies like Purdue Pharma knowingly pushed OxyContin, downplaying its addictive nature, leading to hundreds of thousands of overdose deaths. Or consider the Vioxx scandal, where Merck's painkiller was linked to tens of thousands of heart attacks before its withdrawal. These aren't accidents; they're calculated risks, much like a mob boss weighing the cost of a hit against the gain. The difference? Big Pharma buries its bodies in statistics and settlements—$3 billion here, $2.3 billion there—while maintaining a veneer of respectability.
Bribery, another mob hallmark, is equally pervasive in Big Pharma. Rost's mention of corrupting politicians finds echoes in the millions spent on lobbying each year—over $300 million in the U.S. in 2022 alone. Drug companies fund campaigns, draft legislation, and secure tax breaks, ensuring their interests trump public health. The revolving door between regulators and industry is notorious: former FDA officials often land cushy Big Pharma jobs, just as mob payoffs secure police loyalty. And then there's the direct influence on doctors—lavish gifts, sponsored conferences, and kickbacks for prescribing certain drugs—akin to the mob's street-level hustlers greasing palms to keep the operation running.
What's most chilling, as Rost notes, is the psychology at play. Individually, Big Pharma executives might be "law-abiding citizens"—churchgoers, philanthropists, family people. But within the corporate machine, a transformation occurs. The group dynamic absolves personal guilt; profit becomes the moral compass. This is the banality of evil writ large—executives approving price hikes that kill, or burying studies showing harm, because the bottom line justifies it. It's not unlike mob soldiers committing atrocities under orders, their conscience outsourced to the family. In Big Pharma, the "family" is the corporation, and the code is shareholder value.
The final parallel lies in impunity. The mob evades justice through fear and influence; Big Pharma does it through wealth and PR. Fines, however hefty, are slaps on the wrist—Pfizer's $2.3 billion settlement in 2009 for illegal marketing was a fraction of its revenue. No executives go to jail; no real accountability sticks. Like a mob boss insulated by layers of lieutenants, Big Pharma's leaders hide behind corporate shields, emerging to donate a hospital wing and polish their image.
In Rost's view, Big Pharma isn't just a business—it's a syndicate, operating with the ruthlessness of the mob but the polish of a Fortune 500 company. The wealth, the deaths, the corruption, the groupthink—it's all there, wrapped in a lab coat instead of a pinstripe suit.