The tale of Martin Shkreli is practically Shakespearean: A brash hedge fund investor buys the rights to a cheap generic drug, then dramatically raises the price. After a public outcry, he brazenly defends the high price. He is arrested by the FBI on unrelated fraud charges, after another company finds a way to sell an equivalent drug for a much lower price.

It’s a happy ending in this case, but the pharmaceutical market—which receives about 10 percent of Americans’ health-care spending—remains controversial. We know about Shkreli only because he broadcast his business practices as entertainment. If he had doubled the cost of Daraprim quietly—as many drug companies do—it’s likely few would have noticed or cared.

Manufacturers often point to the cost of developing a new drug to justify high prices. Pharmaceutical companies have to spend millions of dollars years before a drug can be released. If a drug doesn’t work as expected or if the side effects are deemed too dangerous, the company can’t recoup any of that cost.

So manufacturers have to make their money selling the drugs that do work—or heavily advertise the drugs that work a little bit. Most companies spend billions more on marketing and advertising than on research and development.

This system rewards the drugs that will make the greatest profit—far more than it rewards helping the most people. A drug that treats hepatitis, say, is a safe bet: you can price a new medication just a little lower than the cost of a liver transplant. Meanwhile, new antibiotics are needed around the world to keep pace with bacterial resistance. But current treatments are too cheap for new drugs to make a profit.

The problem of drug prices is inseparable from the problem with modern healthcare: More illnesses to treat means higher profits, as long as someone’s paying. Meeting the unique needs of the poor and keeping people healthy in the first place just aren’t profitable. When rich people get really sick, on the other hand, it’s a financial boon for doctors, hospitals, and drug makers.

My fellow physicians often joke that if the benefits of regular exercise, a healthy diet, a decent job, or even strong communities could be put in a pill, insurers would pay thousands of dollars for a single dose. Many diseases are linked to activities that doctors can’t control; it would be far better to find ways to encourage healthy behavior than to spend billions on a new drug.

Further, health is about far more than just individual bodies. Something’s very wrong with our corporate body when the wealthy few can take a pill for sexual dysfunction (real or imagined), while far more people can’t afford an inhaler for asthma. Even when we do pay for health care for the poor, too often it’s skewed toward dealing with emergencies.

What can we do to influence such a powerful system? The most important personal step is to ask how we can improve our health while using pills judiciously. When your doctor prescribes a medication, especially if it is a new, name-brand drug, press to find out whether the benefits are actually worth the cost (to you or to society through insurance), and whether there are alternatives.

If you don’t need medication yourself, speak up for others. Don’t hesitate to ask a doctor about holistic health on behalf of a family member. Advocate for policies that will shift the balance of power, like allowing Medicare to negotiate more aggressively with drug companies (currently that’s banned by law); banning prescription drug advertising altogether (as the American Medical Association called for in November); and spending more on research that will help the greatest number globally.

Until our healthcare system is reoriented to promote health instead of treating illness, the sick will always represent someone else’s profit margin. Until we are committed to caring for our communities’ weakest members, we will find vultures like Shkreli circling above us. And until we see the power God has given us—including knowledge of medicine—as a resource for living faithfully with both health and illness, research labs and the market will gravitate only toward problems that expensive pills can solve.

Matthew Loftus teaches health workers and practices family medicine in South Sudan with his family. Follow their story at

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