What’s even worse than regulatory capture? Epistemic capture. I’ll explain:

Every step in the knowledge production process in science and medicine is captured by the pharmaceutical industry.

• Medical school textbooks are often written by academics with a financial conflict of interest.

• Medical school curriculum is dictated from above, professors are not free to teach whatever they want like in other departments in a university.

• The top 2/3rds of universities own stock in pharmaceutical companies

• 2/3rds of medical school department chairs have a financial conflict of interest

• 2/3rds of medical school researchers have financial conflicts of interest.

• Big Pharma is smart, they don’t buy off everyone, they just buy off the best universities and the leaders in the department and then everyone else falls into line.

• Most clinical trials are conducted by for-profit Contract Research Organizations in China and the third world.

• A large percentage (perhaps as much as 40%) of medical journal articles are ghost written by the pharmaceutical industry.

• The CDC, FDA, NIH, and EPA all have side “foundations” that enable them to take corporate contributions.

• Federal officials are allowed to own stock in the companies that they regulate.

• The pharmaceutical industry spends $27 billion dollars per year on drug promotions to influence the prescribing practices of doctors.

• “Standards of care” are usually written by doctors with financial conflicts of interest.

• Continuing medical education is sponsored by Big Pharma.

• The regulatory body that accredits private health insurance companies is stacked with industry representatives.

From the first day of medical school to the final years of practice, doctors live inside an epistemic bubble carefully engineered by the pharmaceutical industry. What I’m describing here is bigger than “conflict of interest” — it’s systemic capture of the entire knowledge-production process.

Philosophers of science call this Epistemic Capture which is when industry controls the conditions of knowledge production — what gets researched, how, and what counts as evidence. The problem is not one bad regulator or one compromised agency. The entire system of knowledge production in science and medicine needs to be overhauled to liberate it from the biases and distortions imposed by the pharmaceutical industry.