THE PHARMACEUTICAL OCCUPATION - How Big Pharma Colonized European Health Policy and Made Eastern Europe Its Testing Ground

They call it healthcare regulation. They call it patient protection. They call it innovation. It's none of those things. The European Medicines Agency is a revolving door between Brussels and pharmaceutical boardrooms, Eastern Europe is a clinical trial playground where "treatment-naïve" patients are code for desperate and cheap, and €580 billion in pharma profits over five years dwarfs the money spent on actually discovering new drugs. This isn't health policy. It's occupation. And Brussels is the fucking collaborator.

November 2024: The European Medicines Agency recommended 114 new medicines for approval. Emer Cooke, EMA's Executive Director, called it "the first time since 2009 that we have been able to deliver more than 100 positive opinions."

They celebrated this as innovation. As progress. As Europe leading global healthcare.

What they didn't mention: Who sits on the committees approving these drugs. Where the clinical trials testing these drugs happened. And who profits when €600+ billion flows through pharmaceutical markets Brussels supposedly regulates.

Because if you follow the money, and Brussels desperately doesn't want you to—you find something ugly. The EMA isn't regulating Big Pharma. It's serving it. And Eastern Europe isn't benefiting from European healthcare integration.

It's the testing ground where pharmaceutical companies find cheap patients, lax oversight, and governments desperate enough to say yes to anything.

The Revolving Door Nobody Talks About

The European Medicines Agency employs about 600 people. They evaluate drugs. They approve treatments. They're supposed to protect 450 million Europeans from unsafe medicines.

But here's what the EMA's own conflict of interest policy admits: when scientific committee members or experts plan to take jobs in the pharmaceutical industry, they must immediately stop participating in drug evaluations.

Read that again. The EMA's rules exist because the revolving door between pharma companies and EU regulators is so common they needed a fucking policy for it.

And even this weak-ass policy only kicked in after massive pressure. The EMA didn't tighten these rules out of ethical commitment, they did it because the corruption was getting too obvious to ignore.

The policy says experts planning to join pharma must halt involvement "immediately." But it says nothing about experts who already worked for pharma before joining the EMA. Or who consult for pharma while serving on committees. Or who return to pharma after their EMA stint ends.

The revolving door only spins one direction: from pharma, through Brussels, back to pharma. And the people making billion-euro approval decisions know exactly where their next paycheck is coming from.

Where They Test: Eastern Europe as Laboratory

Poland. Hungary. Romania. Bulgaria. The Czech Republic. Slovakia.

These six countries alone conducted over 13,000 clinical trials between 2012 and 2022. Poland led with 4,134 trials. Hungary followed with 3,845. Bulgaria, with only 7 million people, hosted 2,049 trials.

Bulgaria ranked 8th globally in the number of subjects recruited for clinical trials according to FDA reports. Thirteen out of 50 novel drugs approved by the FDA in 2021 underwent studies in Bulgaria.

The pharmaceutical industry calls it "strategic patient population access." Brussels calls it "clinical research capacity building." The industry trade publications are more honest: they call Eastern Europeans "treatment-naïve patient populations."

Translation: people who haven't been able to afford the latest drugs because their healthcare systems are systematically underfunded compared to Western Europe. So when a pharmaceutical company offers a clinical trial, free treatment, close monitoring, hope, people say yes.

Not because the trial is their best medical option. Because it's their only option.

And pharma companies know it. They explicitly market Eastern Europe to sponsors based on "rapid patient recruitment," "fewer competing trials," and "cost-effectiveness."

Cost-effectiveness. That's the sanitized term for "we can run trials here cheaper than in Germany or France."

Cheaper because the grants paid to clinical sites are lower. Cheaper because regulatory oversight is easier to navigate. Cheaper because, let's be fucking honest, a Polish or Romanian patient is valued less than a German or Dutch one.

The Clinical Trial Economy Brussels Built

Phase III trials—the final testing before a drug hits the market, dominate Eastern European clinical research. Between 62% and 74% of all trials in Poland, Romania, Bulgaria, Hungary, and Slovakia are Phase III studies.

Phase III trials are where pharmaceutical companies gather the data they need for marketing approval. They're expensive. They require thousands of patients. And they determine whether a drug becomes a billion-dollar blockbuster or gets shelved.

So pharma offshores Phase III to Eastern Europe. Recruit patients faster. Run trials cheaper. Get the approval data Brussels needs.

And what does Eastern Europe get in return?

Access to experimental treatments during the trial. Then nothing. Because once the drug gets approved and hits the market, Eastern European patients can't afford it.

The industry's own data shows access inequality across Europe even after approval. Drugs approved by the EMA take years longer to become available in Poland, Romania, or Bulgaria than in Germany or the Netherlands, assuming they become available at all.

The same patients who risked their health testing these drugs in clinical trials can't access them once they're proven safe and effective.

Because pricing and reimbursement are negotiated country by country. And pharmaceutical companies prioritize rich markets.

Bristol-Myers Squibb's cancer drug Opdivo? Approved by the EMA in 2015. Still wasn't reimbursed in Ireland by 2023 because the company and Irish government couldn't agree on price. Meanwhile, German patients had access within months.

This is the system Brussels built and maintains. The EMA approves drugs for the entire EU. But access depends on how much your government can pay.

Eastern Europeans test the drugs. Western Europeans get them first. And pharma profits from both.

The Regulatory Capture Nobody Admits

The EMA was founded in 1995 with funding from both the European Union and the pharmaceutical industry.

Read that again. The agency regulating pharma is funded by pharma.

They don't even hide it. The EMA's 2025 budget is over €600 million, a 24% increase from 2024. Much of this comes from fees pharmaceutical companies pay for drug evaluations.

So pharma pays Brussels to evaluate its drugs. Brussels employs evaluators who often came from, or are heading to, pharma jobs. And Eastern Europe provides the cheap clinical trial data that makes approval faster and easier.

This isn't regulation. It's a business partnership where the regulated industry is also a customer, a funder, and a future employer for the regulators.

And when things go wrong? The EMA investigates itself.

During COVID-19 vaccine approval, the EMA suffered a cyberattack that leaked documents showing internal concerns about low production quality in Pfizer's mRNA vaccine and regulators' efforts to have Pfizer rectify deficiencies.

The public found out about quality problems from hackers, not from EMA transparency.

And remember: this was during the biggest public health emergency in a century, when EMA was supposedly operating with maximum diligence.

If they're this sloppy when the world is watching, what happens the rest of the time?

The Profit Machine Brussels Protects

Between 2019 and 2023, the 15 largest European and US pharmaceutical companies made €580 billion in profit after tax.

In the same period, they spent €572 billion on research and development.

So they made more profit than they spent developing drugs. By €8 billion.

And they paid €558 billion to shareholders in dividends and stock buybacks. More than they spent on R&D.

Johnson & Johnson, Pfizer, Novartis, Bristol-Myers Squibb, Novo Nordisk, and AbbVie all paid more to shareholders than they invested in discovering new medicines.

But pharma executives constantly cite expensive R&D costs to justify high drug prices. "We need high prices to fund innovation," they say.

The numbers don't lie. They're not funding innovation. They're extracting profit.

And Brussels helps them do it.

The EMA approves drugs at prices pharma sets. EU member states negotiate individually, meaning they have less leverage than if they negotiated collectively. And pharma stashes profits in tax havens like Ireland, Netherlands, Luxembourg, and Switzerland.

Over 1,300 subsidiaries in tax havens across the 15 biggest pharma companies. Billions in profits shifting through Dublin and Amsterdam to avoid taxes.

Money that could fund European healthcare systems is instead parked in tax havens while Brussels writes reports about "improving patient access."

The COVID Windfall Nobody Forgot

Five years after COVID began, the pharmaceutical industry's pandemic profits are still compounding.

Pfizer and BioNTech made €90+ billion from COVID vaccines. Then they quadrupled the price once governments stopped buying in bulk.

Moderna went from a company that had never brought a product to market to a $100+ billion valuation overnight.

And the EMA fast-tracked approvals using emergency procedures that bypassed normal scrutiny, procedures that von der Leyen's deleted text messages with Pfizer's CEO showed were negotiated in private, with zero transparency.

Brussels calls this "crisis response." It was a blank check.

And what did Europeans get? Vaccines that worked, yes. But also vaccine mandates enforced through the same fear-based control mechanisms Brussels perfected during COVID. Digital health certificates that became prototypes for EU-wide digital identity systems. And pharmaceutical companies that made more money in two years than most make in a decade.

Did the EMA demand lower prices in exchange for fast-track approval? No.

Did Brussels require pharma to share vaccine technology with other manufacturers to increase global supply? No.

Did the EU ensure vaccine profits were capped to prevent profiteering during a pandemic? Fuck no.

They gave pharma everything it wanted. And pharma delivered billions in revenue while millions died unvaccinated in poorer countries.

This is the system working exactly as designed.

The Oversight That Doesn't Exist

In Poland—one of Europe's biggest clinical trial markets, the national audit office found "uneconomical, illegal and unreliable activities" in clinical trial oversight.

Their conclusion: "Pharmaceutical companies have more influence in conducting, financing and financial control of clinical research than public institutions."

Think about that. In an EU member state, pharma companies control their own oversight.

The auditors found the Ministry of Health exercised unreliable supervision. Regulations were chaotic and unclear. Conflict of interest rules barely existed. And clinical trial data was controlled by the companies running the trials, not by regulators.

But Poland isn't an outlier. It's the model.

Across Eastern Europe, pharmaceutical companies explicitly market the region to sponsors based on "harmonized regulatory environment" and "streamlined approval processes."

Streamlined. That's corporate-speak for "easier to get through."

And when Eastern European countries joined the EU, they adopted Brussels' clinical trial framework, the same framework designed in consultation with the pharmaceutical industry.

So now clinical trials run smoother, faster, and cheaper across Eastern Europe. Because Brussels standardized the rules to benefit pharma.

The EMA calls this "harmonization." Eastern European patients call it Monday.

The Testing Ground Brussels Maintains

Eastern European clinical trial participants are described by industry as having "lower trial density", meaning fewer competing studies for the same patients.

In plain language: it's easier to recruit patients in Poland or Romania than in Germany or France because there's less competition from other pharma companies running trials.

And pharma trade publications frame this as an advantage for sponsors.

They don't mention that lower trial density exists because Eastern European healthcare systems can't afford as many cutting-edge treatments. So patients volunteer for trials to access medicine they couldn't otherwise get.

The publications talk about "treatment-naïve populations" like it's a neutral scientific term.

It's not. It means people who have been systematically denied access to modern therapies—so when a trial offers one, they say yes out of desperation, not choice.

And Brussels not only allows this system, it built it.

The EU Clinical Trials Regulation, implemented across all member states, was supposed to harmonize oversight and protect patients.

Instead, it harmonized the process to make clinical trials easier to run across multiple countries simultaneously. It standardized forms, timelines, and approval mechanisms.

For whose benefit? Not patients. They still can't access the drugs after trials end.

For pharmaceutical companies. Who can now run multi-country trials with less bureaucratic friction.

And the EMA, funded partly by Pharma fees, approved this framework.

The Access Inequality Brussels Ignores

After the EMA approves a drug, each EU member state negotiates its own price and reimbursement deal with the manufacturer.

Rich countries, Germany, France, Netherlands, Nordics, negotiate quickly and get access within months.

Poorer countries, Poland, Romania, Bulgaria, Baltic states, wait years. If they get access at all.

Bristol-Myers Squibb's cancer drug Opdivo was approved by the EMA in 2015. Ireland still didn't have reimbursement by 2023 because the company and government couldn't agree on price.

Think about that. An EMA-approved cancer treatment. Available in Germany and France. Not reimbursed in Ireland for eight years because pharma wouldn't accept Ireland's offered price.

And Ireland is a rich country. Poland gets it worse. Romania worse still.

So Eastern Europeans volunteer for clinical trials. They provide the data that gets drugs approved. Then they watch as those same drugs become available to wealthier Europeans first, or exclusively.

Brussels calls this "market dynamics". Eastern Europeans call it betrayal.

The EU is supposed to guarantee equal access. But in pharmaceuticals, equal access is a lie. Western Europe gets the drugs. Eastern Europe gets the trials.

And the EMA, whose approval theoretically grants access to all 450 million Europeans—doesn't give a fuck about this inequality.

Because the EMA approves drugs. Not access. Their job is to rubber-stamp Pharma products, not ensure Europeans can afford them.

The Profits Stashed Offshore

The pharmaceutical industry's €580 billion in profits between 2019 and 2023 didn't stay in the countries where drugs were sold.

It flowed through over 1,300 pharma subsidiaries in European tax havens.

Ireland. Netherlands. Switzerland. Luxembourg.

The EU Tax Observatory identifies these as among the top five profit-shifting destinations globally.

And pharma uses them aggressively. Some Irish affiliates accumulated hundreds of billions of dollars using versions of the "Double Irish" tax avoidance scheme, supposedly closed, but still functioning under new names.

So European patients pay high drug prices. Governments pay subsidies and research grants. And pharma moves profits offshore to avoid paying taxes in the countries that funded their success.

Meanwhile, those same countries complain they can't afford to reimburse expensive drugs.

No shit. Because the profits leave the country while the costs stay.

And Brussels, which could harmonize pharmaceutical taxation, force transparency, or require reinvestment, does nothing.

Because the same lobby groups that fund EMA operations also lobby the European Commission. And they always win.

The Revolving Door Keeps Spinning

The EMA's December 2024 meeting revised its conflict of interest policy after a public consultation.

They made "clarifications" to definitions. They "aligned" policies. They promised to publish a "high-level overview" of public comments.

What they didn't do: ban committee members from taking pharma jobs after their EMA service. Or require cooling-off periods. Or mandate public disclosure of all industry ties.

The revolving door remains open.

And why wouldn't it? The entire system runs on people who know the pharmaceutical industry intimately. You can't regulate something you don't understand.

But you also can't regulate something when your next job depends on not pissing off the companies you're supposedly overseeing.

This is regulatory capture. Textbook definition.

The regulated industry funds the regulator. Employs former regulators. Hires current regulators after they leave. And uses that access to shape rules in its favor.

And Brussels calls this "expertise-based regulation."

The Fear of Asking Why

Here's what never gets questioned:

Why does the EMA approve drugs at prices that make them inaccessible to millions of Europeans?

Why do Eastern European patients test drugs they'll never be able to afford?

Why does pharma make more profit than it spends on R&D while claiming high prices are necessary for innovation?

Why do pharmaceutical companies control their own oversight in major EU markets?

Why does Brussels allow pharma profits to flow to tax havens instead of funding healthcare?

Ask these questions and you're accused of being anti-science. Anti-innovation. Anti-progress.

Because the pharmaceutical industry has successfully conflated criticism of its business model with opposition to medicine itself.

You can't question drug prices without being labeled anti-vaccine. You can't point out regulatory capture without being called a conspiracy theorist. You can't note that Eastern Europe is exploited without being dismissed as anti-EU.

But the numbers don't lie.

€580 billion in profit. €1,300+ tax haven subsidiaries. 600 EMA employees with revolving-door conflicts. 13,000+ clinical trials in Eastern Europe with systematically unequal access to approved treatments.

This isn't conspiracy. It's documented policy.

And Brussels uses fear to prevent anyone from questioning it. Fear that without pharmaceutical companies, we'd have no new drugs. Fear that regulation would drive innovation away. Fear that criticizing the system means opposing healthcare itself.

It's the same fucking playbook Brussels uses for everything.

The System That Serves Profit

The European Medicines Agency isn't a healthcare regulator. It's a pharmaceutical industry service provider that happens to be funded by taxpayers.

Clinical trials in Eastern Europe aren't medical research. They're cost optimization for companies that can't recruit patients fast enough in wealthier markets.

Drug approvals aren't about patient access. They're about opening European markets to products most Europeans can't afford.

And the €580 billion in pharmaceutical profits wasn't earned by innovation. It was extracted from healthcare budgets while patients died waiting for access to treatments that existed but were priced out of reach.

This is the system Brussels built. The EMA administers it. Pharmaceutical companies profit from it. And Eastern Europeans pay for it with their bodies.

Western Europeans pay for it with their taxes. And everyone pays with reduced access to affordable medicine.

But hey, the EMA recommended 114 new drugs in 2024. Progress, right?

What Happens Next

The pharmaceutical industry knows the current system is under pressure. Drug pricing reform is moving forward in both the US and Europe. Public anger over medicine costs is rising. And even industry publications admit "drug pricing and reimbursement constraints represent the biggest concern for pharmaceutical industry decision makers."

So pharma is adapting. Not by lowering prices. By lobbying harder.

The EMA's 2025-2028 strategy promises to "seize opportunities in a changing medicines landscape." Translation: pharma wants faster approvals, more flexibility, and less scrutiny.

And they'll get it. Because the people writing EMA strategy often come from, or are going to, pharmaceutical companies.

Meanwhile, Eastern European clinical trial recruitment continues to grow. Poland, Romania, and Bulgaria are marketed as "top destinations for clinical research" based on their large "treatment-naïve" populations and cost advantages.

The testing ground expands. The profits flow offshore. The revolving door keeps spinning.

And Brussels will keep calling this "healthcare innovation."

Until enough people realize: innovation that only the rich can access isn't healthcare. It's a luxury product with a body count.

The Truth Nobody Will Admit

The pharmaceutical industry doesn't need the European Union.

But the EU needs pharmaceutical companies. For economic growth. For employment. For tax revenue (the little bit that doesn't get offshored). And for the fiction that Brussels is protecting European health.

So Brussels built a system where Pharma writes the rules, funds the regulators, employs the decision-makers, and profits massively, while millions of Europeans go without access to the medicines those same Europeans helped test.

This isn't failure. It's the system working exactly as designed.

Pharmaceutical companies get billion-dollar profits.

Brussels gets to claim it's advancing European healthcare.

Western European patients get access first, if they can afford it.

Eastern European patients get clinical trials.

And everyone pretends this is normal.

It's not about the patient. It never was.

It's about the profit.

Corporate profit. Bureaucratic power. Regulatory employment pipelines. Industry lobby influence.

And you're funding all of it, either through taxes, clinical trial participation, or drug prices you can't afford.

But Brussels calls it healthcare. The EMA calls it regulation. And pharmaceutical companies call it Tuesday.

Welcome to the European Medicines Agency. Where Eastern Europeans test the drugs. Western Europeans buy them. Pharma takes the profits. And Brussels takes a cut for looking the other way.

This isn't occupation.

It's fucking colonization with a prescription pad.

A. Kade

"They say high drug prices fund innovation. The numbers say pharma makes more profit than it spends on R&D while stashing billions in tax havens. Eastern Europeans test drugs they'll never afford. Western Europeans pay prices that could be half. Brussels regulates nothing but approves everything. This isn't healthcare. It's extraction with a medical license."

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