ABSTRACT
Among the world’s 200 largest companies by market value, 19 are pharmaceutical companies. These enormous entities are commonly called ‘Big Pharma’, representing around 40 percent of the US$1.4 trillion global annual market for medicines, and about two-thirds of the market for brand-name drugs. Big Pharma can be distinguished from other companies – be they generic companies or smaller companies – based on their structural power and monopoly capacity in the global pharmaceutical sector, as well as their high profitability. After identifying the main structures of the sector, this chapter focuses on the dominant pharmaceutical companies captured by the term ‘Big Pharma’. It analyzes the evolution of the pharmaceutical sector and how dominant companies have consolidated their structural power through specific business models (from ‘blockbuster drugs’ to ‘nichebuster drugs’). The chapter then assesses the importance of ‘ghost-management’ strategies deployed in the sector, whereby systematic, behind-the-scenes efforts and tactics are deployed to shape knowledge, ideas, and narratives about specific products. While this chapter builds on the assumption that ghost management is systematic in pharmaceutical markets and should be analyzed as a central feature of corporate power, the empirical analysis further shows that these strategies ultimately result in the biopharmaceutical sector spending more resources on ghost-management than on developing and producing new, innovative pharmaceuticals.
