Many argue that the pharmaceutical industry needs reforms in order to address the major issues of global health, while allowing profits for individual companies. Nobel prize winner and Columbia University professor, Joseph E. Stigiltz explains, "Drug companies spend more on advertising and marketing than on research, more on research on lifestyle drugs than on life saving drugs, and almost nothing on diseases that affect developing countries only." He continues, "This is not surprising. Poor people cannot afford drugs, and drug companies make investments that yield the highest returns." To combat this mindset, Stigiltz proposes a medical prize fund to encourage the financing of drug innovations. A prize system would complement other funding options for pharmaceutical companies and offer a monetary "award" for contributing to less-profitable, but more necessary causes.

Critics argue that the pharmaceutical industry often exhibits an immoral approach toward profit maximization, faking concern for the best interest of the patient or consumer. The best example of this apparent exploitation lies in the story of Prilosec and Nexium. After a five-year patent stretch, the sales of heartburn drug Prilosec provided the pharmaceutical company AstraZeneca

over twenty-six billion dollars. As the drug neared the end of its patent, sales would greatly decrease giving way to cheap generic copies. Hoping to maintain such heavy profit, AstraZeneca decided to design a Prilosec 2.0 in hopes of improving the drug with less potential side effects. By simply removing a single isomer of the chemical composition, Nexium was born. After only slightly beating out Prilosec in a single trial measuring "erosive esophagitis," the new drug hit shelves at top price. In order to keep generic manufactures at bay, AstraZeneca then spent half a billion dollars to advertise the launch. It is now one of the top-selling prescription drugs on the market. Nexium was little more than a repackaged Prilosec and yet AstraZeneca has experienced a new wave of income.

These advertisements work. "If anyone doubts the influence of drug company ads on patients and physicians," says MSNBC chief science and health correspondent, Robert Bazell, in reference to the Nexium ad blitz, "consider all those wasted billions of dollars for a pill that sells for more than six times as much as another drug that does the same thing, made by the same company." Through these marketing campaigns, the pharmaceutical industry influences doctors and consumers alike.

Some pharmaceutical companies, however, do hear the social outcry. Daniel Vasella, the chief executive of Novartis, a Swiss pharmaceutical group with a history of social responsibility, suggests that providing drugs to third world countries isn’t as easy as everyone would like. He warns that no sustainable system could currently provide low-cost innovative medicines to the developing world. The company takes large losses on their pioneering malaria drug, Coartem, meant to treat a disease of the developing world where the ability to pay is extremely limited. "We have no model which would [meet] the need for new drugs in a sustainable way," he says. "You can’t expect for-profit organizations to [develop drugs for third-world diseases] on a large scale. If you want to establish a system where companies systematically invest in this kind of area, you need a different system." His call for reform is not the only voice in the outcry for pharmaceutical change.

Dr. Marcia Angell, former editor of the New England Journal of Medicine, author of The Truth About Drug Companies: How They Deceive Us and What to Do About It, and lecturer at Harvard Medical School, also wants to see the industry reformed. "The public is absolutely dependent on this industry for drugs that people need to take for their health and even their lives… there are some special obligations." Many critics agree that because of people’s reliance on the industry, it should be held to a higher moral standard— the question lies in whether this responsibility should be placed in the private sector or the public sphere. Perhaps Canada does indeed offer a solution. Dr. Angell approves governmental price controls and suggests, "We should be looking at the Canadian system, and maybe import that instead of importing the drugs."