Now that George W. Bush is back in the news with his attacks on Trumpist insurrectionists, it might be worth reviving one of the great lines of his presidency. After the September 11 attack, when Bush decided to go after not just the terrorists who planned the hijackings, but all sorts of people around the world he didn’t like, he lumped them together as “evildoers.” That may not be the most eloquent phrase, but it works well as a description of the modern pharmaceutical industry.

Some may find this description of the pharmaceutical industry abhorrent; after all, they develop life-saving drugs and vaccines, most recently the vaccines against the coronavirus, which have saved millions of lives. But the industry’s story line gives us a very incomplete picture of what it does and how.

Probably the best way to think about the pharmaceutical industry is to imagine an incredibly corrupt fire department. Most of the money that the fire department gets to buy new trucks and other equipment goes right into the pockets of the department’s commissioner and his closest friends. The department may still do its job in the sense that they rush to fires and rescue people trapped by flames, but it costs way more than it should.