Originally published on www.sayerji.substack.com

Layoffs, Lawsuits, and the MAHA Rebellion Paint A Concerning Picture for the World's Largest Employer

Read, comment, and share the X post dedicated to this article: https://x.com/sayerjigmi/status/1965777124658475279

An Industry-Wide Reckoning Transforms America's Healthcare Landscape

Executive Summary

• Mass Industry Contraction: Major pharmaceutical companies including Merck (6,000 layoffs), Moderna, Bristol Myers Squibb, and Novartis have implemented widespread workforce reductions in 2025, totaling thousands of job cuts as the industry faces declining revenues and patent expirations.
• Historic Trust Collapse: Public confidence in pharmaceutical companies has plummeted to record lows, with only 20% of Americans expressing positive views of the industry, while 59% believe business leaders deliberately mislead the public on health issues.
• Regulatory and Legal Pressures: The Trump administration has launched aggressive enforcement against pharmaceutical advertising, while lawsuits over products like Tylenol threaten billions in liability, culminating in major stock declines and investor uncertainty.
• Grassroots MAHA Movement: The "Make America Healthy Again" movement has gained significant political influence, successfully pushing policy changes that challenge pharmaceutical dominance and promote health sovereignty, with global ripple effects across international markets.

Industry on the Brink: Mass Layoffs and Shrinking Fortunes

The U.S. pharmaceutical industry is facing an unprecedented downturn. Once buoyed by blockbuster drugs and pandemic windfalls, Big Pharma is now slashing thousands of jobs amid an industry-wide retrenchment. In August 2025, Merck announced 6,000 global layoffs -- about 8% of its workforce -- in a bid to save $3 billion annually¹. This dramatic cut comes as Merck braces for the patent expiration of its top-selling cancer drug, Keytruda, and grapples with declining vaccine revenues.

Merck is not alone. Moderna, Bristol Myers Squibb (BMS), and Novartis have all unveiled major layoffs in 2025, citing "shifting market demands" and looming patent cliffs². Moderna, for example, is trimming 10% of its staff after its COVID-19 vaccine sales collapsed -- Q1 2025 revenue plunged to just $108 million -- forcing a "difficult but necessary" downsizing³. BMS has enacted four rounds of cuts in 2025 (over 1,300 jobs) to pare costs, and Novartis axed hundreds of U.S. jobs as its heart drug Entresto lost exclusivity.⁴

These mass layoffs underscore a broader decline in Big Pharma's fortunes. After years of sky-high profits, the industry's market dominance is shrinking. Companies are retrenching to survive a perfect storm: post-pandemic demand slumps, fewer new blockbusters, and the Inflation Reduction Act's upcoming drug price controls. Even the stock market's confidence in pharma has wavered; Pfizer and Moderna, once market darlings for their COVID vaccines, have seen their valuations slide as sales dry up. The result is a sector "navigating workforce reductions amid industry-wide cost-cutting" and bracing for leaner times⁵. In short, Big Pharma's long-held growth narrative is cracking -- and the cracks are widening by the day.

Pharma's Army: Bigger than the World's Militaries

This comparison is even more striking than it first appears.

Pharma's Global Workforce

The global pharmaceutical industry employs over 5 million people across R&D, manufacturing, sales, regulatory, and distribution. In the U.S. alone, roughly 1.3–1.5 million people work directly in pharma and biotech, with several million more in health insurance, hospitals, and medical device companies -- all parts of the wider medical-industrial complex. If you zoom out to include the entire healthcare industry (hospitals, nursing, insurance, pharma, devices, etc.), the number balloons to 22+ million U.S. workers (about 14% of the national workforce).

Standing Armies Worldwide

By contrast, the total number of active-duty soldiers worldwide is around 27.4 million according to World Bank/Stockholm International Peace Research Institute data (2020). This includes China (~2 million), India (~1.4 million), the U.S. (~1.3 million), and dozens of smaller militaries combined.

The Striking Comparison

• Pharma & healthcare in the U.S. alone: ~22 million workers.
• Global pharma workforce: ~5 million.
• All active-duty soldiers worldwide: ~27.4 million.

So even just in America, the health-industrial workforce is almost equivalent to the entire planet's standing armies combined. If you include the global pharma + healthcare sector, you're looking at 40–50 million workers -- easily double the world's militaries.

Why It Matters

This framing shows that illness has become an economy larger than war. Entire industries, payrolls, and even national GDP figures depend on the continuation of chronic disease. Pharma's payroll is, in effect, an army -- one mobilized not for defense, but for sustaining a business model of lifelong patients.

And when that "army" starts shrinking (like the 19,112 pharma layoffs in August 2025), the tremors aren't just financial -- they are geopolitical. It suggests a civilization built on disease care rather than health care is no longer sustainable.

Public Trust Hits Historic Lows

Compounding the industry's troubles is a collapse in public trust. Polls show Americans' faith in pharmaceutical companies has sunk to record lows. In a Gallup survey, only 20% of U.S. adults voiced a positive view of the pharma industry, ranking it dead last among major business sectors⁶. Distrust is especially rampant among young people. According to Edelman's 2025 global health trust barometer, 59% of people believe business leaders mislead the public on health issues with information they know to be false or exaggerated⁷. More than half also believe government officials and even journalists are complicit in this health misinformation

View Gallup poll article here.

Such skepticism is historic and striking. "We've never seen that kind of data before," an Edelman analyst noted, as many now feel institutions are "actively preventing them from having access to quality healthcare"*⁸. The younger generation's cynicism is particularly telling. Among 18-34 year olds, 38% say they've outright disregarded doctors' advice in favor of tips from social media -- a 12-point jump in one year⁹. Nearly half prefer guidance from family or friends over medical professionals. Many believe doing their own research can make them "just as knowledgeable" as doctors.¹⁰

This is a profound erosion of authority. The consequences were on display during the COVID-19 era, when segments of the public rejected official narratives on vaccines and treatments. Pharma's reputation, already tarnished by perceptions of profiteering and high drug prices, hit all-time lows during the pandemic. Surveys in 2024 found the pharma and health care sectors "rank relatively low in the American consumer mindset," which experts attribute to anger over high drug costs and safety concerns¹¹. In sum, Big Pharma's credibility is shot -- an industry viewed by many as putting profit over people, now struggling to regain trust it once took for granted.

Lawsuits and Liability Shake Investor Confidence

Adding to Big Pharma's woes is a wave of legal liability that is rattling investors. The latest flashpoint: Tylenol and autism. Hundreds of lawsuits allege that prenatal use of Tylenol (acetaminophen) causes autism or ADHD in children -- claims long dismissed by regulators but now gaining traction. In late 2023, a federal judge dealt these suits a setback by excluding expert testimony as lacking solid evidence, and by August 2024 the judge dismissed all federal Tylenol-autism cases¹². But plaintiffs have appealed, and the litigation threat looms.

Then in September 2025 came a bombshell: U.S. Health Secretary Robert F. Kennedy Jr. -- a noted vaccine skeptic turned official -- signaled he would publicly link Tylenol use in pregnancy to autism in an upcoming report¹³. The news, first reported by The Wall Street Journal, sent shockwaves through the market. Shares of Kenvue, the Johnson & Johnson spinoff that sells Tylenol, plunged 14% in a single day on fears of government validation of these claims¹⁴. Investors suddenly faced the specter of mass tort liability on par with tobacco or opioids, targeting one of the most ubiquitous household drugs.

Breaking: Government Finally Admits Tylenol-Autism Link After Years of Corporate Cover-Up

Sayer Ji · Sep 5

 

Read, comment and share the X post dedicated to this article here: https://x.com/sayerjigmi/status/1964115504081052047

Read full story

Pharma companies are increasingly caught in the crosshairs of litigation over product safety -- from opioids (which have cost manufacturers tens of billions in settlements) to Zantac (recalled over contamination) and now Tylenol. In the Tylenol-autism cases, plaintiffs cite studies suggesting acetaminophen use by expectant mothers is associated with higher rates of neurodevelopmental disorders¹⁵. Leading medical bodies like the American College of Obstetricians and Gynecologists still maintain Tylenol is safe and that correlation is not causation¹⁶. But the court of public opinion may be tilting.

The fact that the U.S. government itself ("gold-standard science," per an HHS spokesperson) is investigating autism's environmental causes -- and may single out a flagship pharma product -- marks a paradigm shift¹⁷. It validates concerns long pushed by alternative health activists and puts the industry on the defensive. As one industry analyst put it, "egregious violations demonstrating harm" are now being prioritized by enforcers¹⁸. For investors, this is chilling: the rules of the game are changing, and Big Pharma's legal shield (built on decades of regulatory support) is crumbling.

A $10-Billion Ad Machine Under Assault

Perhaps nothing illustrates Big Pharma's influence -- and its vulnerability -- better than its advertising empire. The U.S. is one of only two countries in the world that allow direct-to-consumer (DTC) drug ads, and pharma has exploited that freedom to build a $10+ billion marketing engine that blankets American airwaves with drug commercials. In 2024 alone, pharmaceutical companies spent over $10.1 billion on prescription drug ads, with roughly half ($5+ billion) devoted to TV spots and the rest on radio, print, and digital¹⁹.

These ad dollars have been a lifeline for media companies: by one analysis, pharma ads comprised 24.4% of all evening TV news advertising minutes on major networks in early 2025²⁰. In other words, nearly one out of every four commercials on nightly news was for a drug. During the COVID era, viewers couldn't watch CNN or ABC for long without hearing "...ask your doctor if [Drug X] is right for you." Big Pharma was effectively paying the piper -- and calling the tune of legacy media narratives, critics say.

Now that mighty advertising juggernaut is under political and regulatory siege. In September 2025, the Trump administration -- newly returned to power -- launched an aggressive crackdown on DTC pharmaceutical advertising. President Trump signed a presidential memorandum directing Health Secretary RFK Jr. and the FDA to enforce long-ignored rules against misleading drug ads²¹. The FDA immediately announced plans to send out 100 cease-and-desist notices and thousands of warning letters to drugmakers, warning that ads must clearly disclose risks and cannot be deceptive²².

"Pharmaceutical ads hooked this country on prescription drugs. We will shut down that pipeline of deception," vowed Secretary Kennedy in a fiery statement, pledging to require drug companies to disclose "all critical safety facts" in ads²³. The administration also moved to reverse the FDA's 1997 policy that had relaxed TV ad requirements. Going forward, drug commercials must include the full laundry list of side effects and warnings, not just the pleasant imagery and a quick disclaimer directing viewers to a website²⁴.

 

In effect, Washington is yanking the industry back to pre-1997 standards -- a de facto "soft ban" on glossy drug ads that rely on fine print and happy visuals²⁵. Additionally, regulators plan to close loopholes by policing pharma promotions on social media, influencer partnerships, and online pharmacies, areas where stealth marketing has flourished²⁶.

The backlash against pharma advertising has bipartisan momentum. On Capitol Hill, Senators Bernie Sanders and Angus King introduced the End Prescription Drug Ads Now Act, seeking to ban all DTC drug advertising across TV, radio, print, and internet²⁷. "The U.S. and New Zealand are the only countries that still allow these ads," Sanders noted, calling them a driver of unnecessary prescriptions and high drug costs²⁸.

For legacy television, the implications are dire: pharma is the third-largest TV ad category, pouring $6.4 billion into TV in 2024²⁹. If that spigot is tightened or shut off, networks face a major revenue hole. Little wonder PhRMA (the industry's lobby) has scrambled to defend DTC ads as "providing important, fact-based information to patients"³⁰. But the political winds have shifted. After years of debate, America's $10-billion drug advertising machine is finally meeting its day of reckoning.

How Pharma Money Shaped the COVID Narrative

For years, Big Pharma's ad dollars wielded hidden power over media coverage -- never more so than during the COVID-19 pandemic. With news outlets reaping huge profits from vaccine and drug advertisements, critics argue there was a pervasive conflict of interest that stifled dissenting voices. Mainstream TV networks, flush with sponsorship from Pfizer, Moderna, and Merck, often gave limited airtime to doctors or scientists who questioned official COVID policies.

 

Alternative treatments and vaccine safety concerns were frequently dismissed as "misinformation," with those with the largest followings (e.g. 'disinformation dozen') being labeled as 'domestic terrorists,' while commercial breaks bombarded viewers with "brought to you by Pfizer" segments. It did not go unnoticed: Americans saw the pharmaceutical industry's fingerprints on the media narrative, and it further eroded trust. "Pharmaceutical companies are spending billions to influence media coverage, ensuring only positive stories about their drugs and vaccines dominate the headlines," one investigative report observed³¹.

Silenced as Terrorists: Tulsi Gabbard & Global Collusion to Criminalize American Dissent

Sayer Ji · May 23

"This is just one of many alarming actions by the Biden administration--using government power to label concerned parents, vaccine mandate opponents, and other citizens exercising their First Amendment rights as potential domestic extremists."

Read full story

The numbers tell the story. In 2020-2021, as the pandemic raged, over $300 million was spent by healthcare and pharma advertisers on network TV news -- and not a single major network bucked the pro-vaccine narrative³². Throughout the crisis, prime-time cable news advertising by health brands (including pharma) remained high, with no "mass exodus" of sponsors even amid controversies³³. Effectively, the drug industry held veto power over what viewers heard.

Now, with DTC ads under siege and public scrutiny on media collusion, that information monopoly is cracking. Journalists and audiences alike are asking hard questions about how advertising revenue influenced COVID coverage. Was dissent labeled "fake news" because it threatened pharma profits? Did networks overly rely on industry-paid experts? These questions hang in the air as the media begins to divorce itself from Big Pharma's bankroll.

Sayer Ji's Substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

"Make America Healthy Again": The Grassroots Backlash

Fueling these seismic changes is a surging grassroots movement that has declared war on Big Pharma's agenda. Dubbed MAHA -- "Make America Healthy Again" -- this cultural backlash channels the public's frustration into a crusade for health freedom and holistic well-being. MAHA draws support from a broad ecosystem of organizations and activists long skeptical of pharmaceutical dominance.

Front and center is Children's Health Defense (CHD), the nonprofit formerly led by RFK Jr., which has spent years sounding alarms on vaccine safety, environmental toxins, and corporate capture of health agencies³⁴. They are joined by allies like the Organic Consumers Association, Moms Across America, Stand for Health Freedom, and the National Health Federation -- an informal coalition of "health freedom" groups that span concerns from GMO foods to 5G radiation to medical mandates.

MAHA Rising: Florida Citizens Rally at Capitol to Champion Health Freedom

Sayer Ji · Apr 3

Tallahassee, FL - April 3, 2025

Read full story

What unites them is a belief that Americans have become over-medicated, over-vaccinated, and over-exposed to chemicals, and that it's time to reclaim control of our health from corporate interests. Once dismissed as fringe, the MAHA movement has rapidly gained mainstream visibility and political clout. Its rallying cry -- "Make America Healthy Again!" -- deliberately echoes the populist appeal of Trump's "Great Again" slogan, but refocuses it on bodily autonomy and wellness - a truly non-partisan focus, and as American as apple pie when it comes to the prioritization of sovereignty and self-governance above all else.

Reclaiming Our Health Sovereignty: A Modern 1776 Moment

Sayer Ji · Mar 20

(Cinematography and recording generously gifted by: channeledventures.com (http://www.channeledventures.com/)

Read full story

Yesterday, the White House's own Make Our Children Healthy Again Strategy Report validated much of MAHA's platform. The HHS report (authored by Kennedy's MAHA Commission) outlines a sweeping plan to tackle America's chronic disease epidemics by eliminating toxic exposures and curbing overmedication³⁵. It calls for updated dietary guidelines free of food industry influence, new limits on harmful food additives (like petroleum-based dyes and heavy metals in baby food), and revisiting fluoride levels in water³⁶.

Notably, the strategy pledges to "increase oversight and enforcement" against violations of DTC prescription drug advertising laws, albeit stopping short of an outright ad ban³⁷. It also promises to investigate the over-prescription of psychiatric drugs in kids and to fortify safeguards against "corporate capture" of agencies like the FDA³⁸. In essence, the U.S. government -- prodded by MAHA-backed officials -- is beginning to act on the movement's long-standing grievances.

Global Ripple Effects

The rebellion against pharmaceutical overreach is not confined to the United States -- it is increasingly global. Citizens around the world have watched the U.S. turmoil and found resonance in the MAHA message of health sovereignty. From Europe to Asia, trust in health authorities and drug companies has eroded, echoing American sentiments.

A worldwide 2025 survey revealed that majorities across many countries believe health leaders routinely mislead the public, and that "people like me" must take charge of their own health decisions³⁹. In nations like France, Germany, and Australia, new grassroots groups are likewise pushing back against mass vaccination campaigns, questioning high drug prices, and advocating natural remedies -- often citing the same studies and talking points as MAHA.

Meanwhile, foreign competitors are rising -- the dramatic success of Denmark's Novo Nordisk with obesity drugs (briefly making it Europe's most valuable company) underscores that the balance of power in pharma is shifting worldwide. If U.S. firms stumble due to public distrust and legal woes, overseas companies and generic manufacturers may fill the void, further eroding the historical dominance of American pharma giants.

Conclusion: A Reckoning and a New Paradigm

The accelerating collapse of the U.S. pharmaceutical industry is a multi-faceted reckoning -- economic, legal, and moral. An industry long seen as invincible is now bleeding jobs, besieged by lawsuits, distrusted by the public, and increasingly constrained by regulators. Big Pharma's social license to operate -- its legitimacy in the eyes of patients and policymakers -- is evaporating.

In its place, a new ethos is emerging. The slogan "Make America Healthy Again" captures the zeitgeist of a populace yearning to break the drug dependency cycle and reclaim health from corporate hands. This movement's rise signals a broader paradigm shift: from a pharmaceutically driven healthcare model to one emphasizing prevention, transparency, and individual empowerment.

The implications are profound. Legacy media, once under pharma's thumb, may rediscover editorial independence as the ad dollars dry up. Research priorities could turn toward environmental health and nutrition after decades centered on patentable pills. And globally, we may witness more nations challenging the U.S.-led, pharma-centric approach to health policy.

Of course, Big Pharma will not disappear overnight. The industry still invests heavily in R&D and brings forth lifesaving innovations. But its aura of infallibility is gone. In boardrooms from New Brunswick to Basel, pharmaceutical executives are waking up to a new reality in which public opinion can trump even the strongest balance sheet. Investor confidence -- once predicated on ever-expanding drug markets -- has been shaken by the realization that social backlash and political action can slam the brakes on growth.

We are, in effect, watching the mighty fall. As one hard-hitting exposé put it, the pharmaceutical empire built over the past century is "spending billions to keep itself on a pedestal, but the pedestal is crumbling"⁴⁰. What rises from the rubble -- a more humble pharma sector, robust public health reforms, and empowered citizens -- could very well mark the dawn of a healthier era. The collapse of trust in Big Pharma, painful as it is, may be the catharsis needed to truly make America (and the world) healthy again.

Get the book REGENERATE in physical, digital or audiobook form, an international bestseller now in 6 languages.

 

References

1. "Merck to Cut 6,000 Jobs as It Aims for $3 Billion in Cost Savings by 2027," Pharmaceutical Executive, accessed September 10, 2025, https://www.pharmexec.com/view/merck-cut-6-000-jobs-3-billion-cost-savings-2027.

2-5. Ibid.

6. Bureau of Labor Statistics, "Employment in Healthcare Occupations," accessed September 10, 2025.

7. Stockholm International Peace Research Institute, "Military Expenditure Database," 2020, https://www.sipri.org/databases/milex.

8. Pharmaceutical Executive, "Industry Layoffs Tracker," August 2025.

9. "Americans' Perspectives on Pharma and Healthcare Industries Are Low and Low-Ish Compared with Most Other Sectors," HealthPopuli.com, September 19, 2024, https://www.healthpopuli.com/2024/09/19/americans-perspectives-on-pharma-and-healthcare-industries-are-low-and-low-ish-compared-with-most-other-sectors/.

10-13. "Trust in pharma and health care industries plummet with young people leading the way: report," Marketing & Pharma, accessed September 10, 2025, https://marketingandpharma.com/trust-in-pharma-and-health-care-industries-plummet-with-young-people-leading-the-way-report/.

14. "Americans' Perspectives on Pharma and Healthcare Industries."

15-16. "Kennedy to link Tylenol use in pregnancy to autism, report says," Reuters, September 5, 2025, https://www.reuters.com/business/healthcare-pharmaceuticals/kennedy-link-tylenol-use-pregnancy-autism-report-says-2025-09-05/.

17-20. "Kennedy to link Tylenol use in pregnancy to autism, report says," KSL.com, accessed September 10, 2025, https://www.ksl.com/article/51370887/kennedy-to-link-tylenol-use-in-pregnancy-to-autism-report-says.

21. "MAHA Commission Outlines Sweeping Agenda to Target Chronic Disease," Children's Health Defense, accessed September 10, 2025, https://childrenshealthdefense.org/defender/maha-commission-outlines-sweeping-agenda-to-target-chronic-disease/.

22-23. "Did drug companies spend $10 billion on consumer advertising in 2024, making up nearly 25% of evening ad minutes?" Wisconsin Watch, July 2025, https://wisconsinwatch.org/2025/07/drug-companies-advertising-consumer-ads-pharmaceutical-news/.

24-25. "US FDA stepping up enforcement of pharma ad rules, sends letters to companies," Reuters, September 9, 2025, https://www.reuters.com/sustainability/boards-policy-regulation/us-fda-stepping-up-enforcement-pharma-ad-rules-sends-letters-companies-2025-09-09/.

26-29. Ibid.

30-32. "A Drug Ad Crackdown Could Leave Linear TV Feeling Withdrawals," The Wrap, accessed September 10, 2025, https://www.thewrap.com/prescription-drug-ad-crackdown-linear-tv-impact-analysis/.

33. "US FDA stepping up enforcement of pharma ad rules."

34. "Substack," Reform Pharma Now, accessed September 10, 2025, https://reformpharmanow.org/substack/.

35-36. "Advertiser Spending on Primetime News Throughout the Coronavirus Pandemic," Media Engagement, March 2022, https://mediaengagement.org/wp-content/uploads/2022/03/Advertiser-Spending-on-Primetime-News-Throughout-the-Coronavirus-Pandemic-1.pdf.

37-41. "MAHA Commission Outlines Sweeping Agenda to Target Chronic Disease."

42. "Trust in pharma and health care industries plummet with young people leading the way."

43. "Substack," Reform Pharma Now.