Patents, Profits, and Patients: Lessons from Debating Big Pharma at Oxford

Recently, Gerald Posner delivered a series of lectures at Peterson Academy titled Journalism 101. If you’re a writer or journalist, his course—drawing on his extensive experience. I found it invaluable. He delves into how to investigate stories, pull data directly from primary sources, and craft headlines that actually mean something.

Gerald Posner is an American investigative journalist, author, and non-practicing attorney. Posner has authored many bestsellers focusing on conspiracies, history, and crime.

Some of his notable works:

• Case Closed (1993): Argues Lee Harvey Oswald acted alone in JFK’s assassination (Pulitzer finalist, NYT bestseller).

• Killing the Dream (1998): Concludes James Earl Ray acted alone in MLK’s assassination.

• Why America Slept (2003): Examines pre-9/11 intelligence failures.

• God’s Bankers (2015): History of Vatican finances (NYT bestseller).

• PHARMA (2020): Critique of the pharmaceutical industry and opioid crisis.

Big Pharma Profits

In one of his lectures, he makes a compelling argument why big pharma profits should be limited and what impact that has had on society. He interacts personally with some people behind Big Pharma with facts and came up with some unexpected answers. This resonated with me as I’ve written about the Vioxx scandal on Substack (here) and in my book Stopping Pain.

Shorten Patents, Unleash Competition: A Fix for Big Pharma?

Posner wrote the book PHARMA, where he talked about patent monopolies in pharma companies. Near the end of the fifth lecture of his Journalism 101 at the Peterson Academy, one student asked:

“Do you ever find after, say, a book like Big Pharma, you see that—there’s more than, obviously, one variable that leads to these incentives—but do you ever find that maybe if there was, say, no 20-year patent, or maybe a shortened patent where then the companies would be forced to deal with competitors, which, would that likely have, could it be one thing or are you seeing multiple things?”

Posner’s answer was passionate, “Absolutely. I hate the idea of the protected patent monopoly that’s given in pharma.”

In June 2025 Posner participated in an Oxford Union debate with Dame Ijeoma Uchegbu (a nanoscientist, president of Wolfson College at the University of Cambridge) on the motion: “This House believes that profit motives have no place in public health”

Posner and Uchegbu argued in favor of the motion—that profits should have no (or minimal) role, emphasizing how excessive profit motives harm patients. The opposing side included former FDA Commissioner Robert Califf and Dr. Freda Lewis-Hall (former chief medical officer of Pfizer), arguing that profits can drive innovation when properly harnessed. The full debate is available here.

The Pharma side, of course, opened the debate with the assertion arguing that profit motives do have a place—they are essential for driving innovation, funding risky R&D (which costs billions and has high failure rates), and enabling breakthroughs like treatments for rare diseases.

Posner and Uchegbu handily won the debate by making the case for, “Let’s take profit out of health care.” They won that debate by a 10 or 12 to one margin. This is important for people to understand.

Case in Point

Posner then spoke about Senator Estes Kefauver, who was made famous in the ‘50s for investigating the Mafia. He called these Mafia hitmen and everybody before Congress on a televised network, a spectacular success.

Kefauver went after pharma in the early ‘60s and it’s been going on ever since. He had hearings and investigations about profits and everything else. He sent some of his research over to Europe to get ideas, and they came back and said,

“Hey, nobody has a patent like the US, this 20-year protection. And it gets gamed all the time. So that in 1921, two Canadian researchers invented and found insulin, a miracle drug. Fantastic. They sold the licensing rights to Lilly. Those Canadians, the Americans taught them a lesson. Don’t give away the licensing rights, no less. Lilly kept the patent on those licensing rights and the exclusive rights, essentially, of penicillin, for 40 years, by re-jiggering the medicine, by doing ever greening tweaks, by having delivery pens, by making little changes that qualified for an extension of the patent. Pharma companies know how to do it very well.”

Orphan Drugs

There are drugs called orphan drugs, which are drugs made for small patient underserved populations with genetic illnesses. In the early 1980s, Reagan signed the well-intentioned, Orphan Drug Act, to encourage drug companies to make drugs for groups of under 200,000 patients. Why would Pharma spend all this money to go through the regulatory process and make a drug for a small group, sometimes only a few thousand patients, when they could make a cholesterol medication that affects tens of millions of people? This was the reality presented at that time.

Posner explains, “Then the government gave them an incentive. They said, We’ll give you extra time on your patent. We’ll give you an instant period in which nobody can compete. We’ll give you tax credits and everything else. Fantastic. Now pharma companies make orphan drugs. And guess what? The top 10 most expensive drugs in the country, in terms of revenue, eight of them are orphan drugs because they change all the time and they do tweaks to get them approved. Literally, Novartis has a drug for $2 million for delivery for a year.”

Orphan drugs are priced at mind-boggling fees. Novartis’s Zolgensma, a one-time gene therapy priced at $2.125 million. Others are Regenxbio gene therapy for Hunter Syndrome or Capricor for Duchenne muscular dystrophy. These companies exploit incentives through practices like indication “salami-slicing,” or achieve blockbuster profits on orphan-qualified drugs—issues that fuel ongoing debates about balancing rare-disease innovation with affordability and appropriate profit limits in pharmaceuticals.

Azidothymidine (AZT) and AIDS

A little-known fact is that one of the first orphan drugs was for AIDS. It got approval from AZT, which was priced at $10,000 a patient. Dr. Anthony Fauci, then NIAID head, championed AZT’s promise, pushed for expanded access and advocated broadening its use to asymptomatic HIV-positive people in 1989 based on trials—despite toxicity concerns. In the mid-1980s, Burroughs Wellcome (a British pharma company) resynthesized it, screened it for anti-HIV activity, and sent samples to the National Cancer Institute (NCI), which is part of the National Institutes of Health (NIH). Dr. Samuel Broder tested it and demonstrated it inhibited HIV replication in lab and early human studies (a scene that would be repeated decades later). Even though the NIH had done most of the research, it was Burroughs who took the patent and then made the money.

The Taxpayers Working for Pharma

This piece shows how government tax payer funds are used to develop drugs for private pharma companies to make billions in profit.

“So, time and time again, over the years since the 1930s, the NIH have spent hundreds of billions of taxpayer money on health research and grant funds, leading to many of the drugs that are now on the market. But the drug companies own the patent. They’ve even fought the government to keep the patent away from them. So, when a drug was put out in the 2000s, you had Truvada, which became a pre-exposure prophylactic drug that might prevent the spread of AIDS.

And the NIH did research on that along with funding from the Gates Foundation. And the company that owned the patent for that drug had never even used it, never had it on the market. The government tried to patent it, to distribute the drug inexpensively. But Gilead fought them, won in court, kept the patent, and made billions of dollars. That, to me, is wrong.”

Posner’s Big Idea on Pharma Patents

Posner posited a new idea of the patent: “What happens if you were given an exclusive patent, you put in all the money for the drug; you get back all of your money that you spent to create the drug, the billion dollars or whatever you spent up to that time, and then you make a 10% profit for three years, guaranteed, and then it’s licensed to all comers. So, you can license and make money for all comers at that point.

Posner then asked the former medical director of Pfizer. “Would that be good? The answer is was she was horrified. She responded, a 10% profit? You’re going to limit drug companies to making only 10% on a drug that they discovered, for only three years? Pharma didn’t like that at all.”

At the same time, Posner agrees in free markets and capitalism and doesn’t like overregulation to the point where the government says, “We’re going to run the health care system.” Currently we’re seeing this in real time with the result of the government allowing health care insurers to endlessly increase health care premiums to the point of unaffordability. But Posner remarks, “at the same time, I’d like to see a little more on what I call the drug and patent end.”

The Mic Drop Part his lecture

“And the last thing on this, sorry for the long answer, but I obviously feel passionate about this. I get people who come up to me and say, “Oh, you fool. You’re a journalist. You’re not in the company. We spend so much money to get drugs approved. It’s so expensive with clinical trials, it’s a multi-billion-dollar process. So, we take this risk. Not every drug makes it. And therefore, we need to charge high prices to recoup all this.” OK, that sounds good. That sounds fair.

But then Posner asks them something. “Take the top 10 biggest-grossing drug companies in the world, and they spend more on average every year on share buybacks and promotion than they do on research and development. So, you know what? Let’s cut back on the share buybacks and the promotions, and maybe you could cut prices a little. So, yes, I think we can have shortened patent periods.”

The final point here is that Merck spent more on marketing Vioxx than on any other drug in history, were sued for billions, and in the end still profited billions of dollars. So I agree with Posner that we can limit pharma at least a little.

https://petersonacademy.com/courses/journalism-101