Influence, Deviations, and Excesses in the Pharmaceutical Sector

Since Alexander Fleming’s discovery of penicillin in 1928, the pharmaceutical sector has expanded rapidly, becoming one of the most powerful segments of the global economy today, with estimated annual revenues of approximately US$ 1.5 trillion and major corporations valued at hundreds of billions of dollars. Although scientific and technological advances and socioeconomic transformations have driven drug research and development, yielding substantial gains, critical scholarship has emphasized controversial practices of corporate influence - here synthesized as “Influence, Deviations, and Excesses” - that promote growth, profitability, and the consolidation of power, at times in conflict with the collective interest and public health. In this context, the present article adopts an exploratory-descriptive design and a mixed-methods approach, triangulating public datasets, institutional documents, and a critical review of the international literature to map and describe mechanisms of corporate influence in the pharmaceutical sector across eight axes: (i) lobbying and electoral financing; (ii) influence over regulatory and oversight bodies; (iii) influence on patient organizations; (iv) influence on the development of clinical guidelines; (v) manipulation, promotion, and concealment of pharmaceutical research and trials; (vi) ghostwriting; (vii) strategies of diagnostic expansion and disease promotion; and (viii) the funding and provision of benefits to prescribers and institutions, including psychosocial mechanisms and formative dimensions. The findings indicate that corporate influence is structured across multiple scales and operates in a manner that is simultaneously visible and diffuse. At the political level, lobbying and electoral financing emerge as central instruments for shaping the normative and regulatory environment, with a progressive expansion of investments. In the regulatory sphere, the recurrence of conflicts of interest in advisory committees and the circulation of personnel between agencies and companies suggest vulnerabilities to institutional capture, with implications for drug approval, oversight, and withdrawal processes. In the scientific domain, industry sponsorship is associated with biases that may affect everything from trial design and conduct to the selective publication of results, as well as practices such as ghostwriting and “market conditioning” strategies, undermining the credibility and circulation of evidence. In parallel, industry involvement is evident in diagnostic expansion and the medicalization of conditions of everyday life, enlarging markets and potentially obscuring social determinants and non-pharmacological approaches. In clinical practice, payments and transfers of value to prescribers and educational institutions are associated with shifts in prescribing patterns, increased costs, and preferential use of promoted drugs, including through low-value benefits mediated by cognitive biases.