In Pharmaconomics, journalist Nick Dearden recounts his investigation that made him realise how we make our medicines and finds that Big Pharma is failing us, with catastrophic consequences. These big companies are more interested in profits than health. That became clear when governments rushed to produce vaccines during the COVID-19 pandemic. Behind the much-vaunted scientific advances, made mostly with public funds, Big Pharma found new ways to extract billions more from Western governments while abandoning the Global South. But this is just one recent episode in a long history of the financialisation of medicine: from Purdue's rapacious marketing of the highly addictive OxyContin, to Martin Shkreli's price hikes on a life-saving drug, to the 4.5 million South Africans unnecessarily deprived of HIV/AIDS medication. Since the 1990s, Big Pharma has done everything it can to protect its ownership through the patent system. As a result, business has become less about researching new drugs and more about creating monopolies. This system has helped restructure our economy away from invention and production to benefit financial markets. It has radically altered the relationship between rich and poor countries, as access to new drugs and permission to manufacture them is ruthlessly policed. In response, Dearden offers a path to a fairer and safer system for all.