The UK-US pharmaceuticals deal will increase cost and deaths

For its healthcare, the UK looks to the west but should look to the east

The UK-US pharmaceuticals deal will increase cost and deaths

For its healthcare, the UK looks to the west but should look to the east

On 1 December 2025, the UK government issued the press release, “Landmark UK-US pharmaceuticals deal to safeguard medicines access and drive vital investment for UK patients and businesses.”¹ The subtitle was that the “Milestone deal secures UK’s medicines access for patients, with a wide range of groundbreaking new treatments to reach NHS front-line quicker.”

On 1 July 2026, the consequences for the Brits were analysed in the BMJ.² They are disastrous, which the politicians must have known they would be.³

Why the deal?

The deal is so bizarre and encroaches so much on British sovereignty that the first question that comes to mind is why on earth the Brits agreed to it.

Amidst all the nauseating hype in the press release, this sentence explains it: “Move will ignite economic growth – with 0% tariffs agreed on UK medicines to US” (for at least 3 years).¹

But the deal is not transparent. Advocacy for making its details public, especially the impact assessment, has garnered support from the House of Lords and triggered legal action.² BMJ’s editor noted that the deal was forced through without political scrutiny or discussion in parliament.³

Clearly, the deal is a result of the kleptocratic gangster regime President Donald Trump has introduced in the United States. He has enriched himself and his family without precedent,⁴ invades other countries, has threatened to take Greenland by military force,⁵ threatens leaders of independent countries who don’t agree with his ideas, and punishes nations with his highly arbitrary and volatile tariffs. Earlier this month, he even coined the idea that the US should impose a 20% fee on cargo passing through the Strait of Hormuz.⁶

Trump always promises that he will lower or drop the tariffs if foreign leaders appease him, and British politicians swallowed the deal hook, line, and sinker.²

We are not so dumb in mainland Europe. Drug exports are the biggest income for my country, Denmark, but we do not enter foolish deals with Trump. And Germany, Europe’s biggest economy, is moving in the exact opposite direction by restricting its drug budget and rebuffing Trump’s arguments.³

In the US, there are no effective price controls, which is why Americans pay vastly more for their drugs than we do in Europe. But instead of cleaning up the mess US ultra capitalism has created, Trump has put the blame on Europe for paying too little for drugs and tries to punish us for being more reasonable and less corrupt than US politicians.

Trump has bought into the drug industry’s false argument that high drug prices are necessary for innovation. The facts are that most innovations come from publicly funded laboratories and that there is very little innovation in the drug industry.^7-9 The only thing that is achieved by higher drug prices is to make an industry and its executives that are already obscenely rich, richer.

But UK ministers have emphasised proposed benefits of the agreement, including incentives for innovation and access to new medicines, and there have been claims that higher UK medicine prices will stimulate pharmaceutical innovation.²

The British calamity might not have happened if ruthless and amoral politicians like Nigel Farage and Boris Johnson had not lied to the Brits about the wonders awaiting them if they voted for Brexit - leaving the European Union. The EU has been very firm in telling Trump that he could expect retaliatory tariffs if he imposed unreasonable tariffs on EU countries, which the EU did during Trump’s first presidency.

What do we know about the deal?

The press release is extremely long, six pages.¹ It is so full of untenable statements and unrealistic fantasies that it takes some determination just to get through it. I cannot recall having ever seen a more misleading press release. Representatives from the government, the drug industry, and patient organisations say about the same, which is one big cheer for the deal, e.g. “This deal is a real win,” “This is a vital agreement,” and “This deal is fundamentally about putting patients first.”

It is not. As BMJ’s editor noted, the deal “puts America First:”³

“The deal sacrifices UK health and wealth, contrary to the rhetoric of government ministers and unchecked hyperbole, from senior health people who should know better … Happy birthday, USA: we’ll kill our poor people to make your rich companies richer.”

The bottom line of the deal is that it commits the UK National Health Service (NHS) to substantially higher expenditure on branded medicines over the coming decade through changes to drug pricing arrangements and health technology assessment.² This means that highly priced drugs with doubtful benefits, which would not have been used before the deal, will now become used.

The deal damages the integrity of the National Institute for Health and Care Excellence (NICE), threatening its status as the world’s premier national drug evaluation agency.³

The UK government has agreed to increase expenditure on new medicines from 0.3% to at least 0.6% of gross domestic profit (GDP) in 2036 without corresponding increases in available NHS expenditure.² It is absurd to accept such a deal in a world where our prescription drugs are already the leading cause of death, ahead of heart disease and cancer.¹⁰ But the press release argues that “Investing in medicines helps keep people healthier for longer, reducing pressure on the health service over the longer-term.”¹   

The authors of the analysis article estimated that by 2036, the deal is likely to result in over 200,000 excess deaths.² Moreover, when less money becomes available for other interventions than drugs, the harmful effects are likely to have greater effects in areas with higher deprivation and baseline mortality, further entrenching existing health inequalities, which continue to grow in the UK, just as they do in the US under Trump.¹¹

What did we already know?

We have known for decades that capitalism and healthcare are very poor bed fellows,⁷ but the propaganda has made nearly half of all Americans believe they have best healthcare in the world, albeit with a clear political divide, 68% of the Republicans and 32% of Democrats.¹²

The beliefs that what is good for big pharma is also good for the people and that market forces will solve all problems are widespread in the US on both sides of the aisle but they contradicted by the facts. The Unites States has the most ineffective healthcare system in the developed world^7,13-15 and a relatively low healthy life expectancy despite using far more resources than any other country, about double as much of its Gross National Product as in other industrialised countries.^7,11

A 2008 report from the Commonwealth Fund found that the Unites States ranked last among 19 industrialised countries across a range of measures of healthcare.¹⁵ The report estimated that if the United States attained the same performance indicators achieved in other industrialised countries, at least 100,000 lives and at least $100 billion could be saved every year, and it tied much of the problem to a weak base of primary care doctors. A study that compared 3075 US counties found that every 20% increase in primary care physicians was associated with a 6% reduction in total mortality.¹⁶

The health disadvantage of Americans is not only because of extreme income inequalities and widespread poverty. It is also seen among those with health insurance, a college education, higher incomes and healthy behaviours.¹⁷ Even for deaths considered amenable to healthcare, Americans fare poorly. A report from 2008 showed that the decline in amenable mortality in 19 industrialised countries averaged 16% over a 5-year period, whereas it was only 4% for the United States.¹⁸

In the US, health for all is non-existent. A 2026 report from the Commonwealth Fund noted that Americans die prematurely at among the highest rates among industrialised countries; have among the highest maternal deaths and suicides; are more likely to die from avoidable causes; with inequities within the US by sex, ethnicity, and rural location.¹¹

Why does the UK join the US downhill course in healthcare?

The US healthcare gap is growing and has worsened considerably during Trump’s second presidency.¹¹ I noted in my 2013 book, “Deadly medicines and organised crime: How big pharma has corrupted health care,”⁷ that the UK has come to resemble the US more and more, as it has moved towards greater privatisation of healthcare. A 2009 report showed that the healthy life expectancy in the UK is lower than in most other European countries, and that the prevalence of chronic disease and disability lies between that in the US and the rest of Europe.¹⁹

I also wrote that the sobering facts explain why the vast majority of European doctors are left wing when it comes to healthcare and that “We love our public health service, which US politicians scornfully call socialised medicine.”

UK healthcare has suffered tremendously because of incompetent, short-sighted and opportunistic politicians who prefer to look to the west rather than to the east. In the Nordic countries, we treasure equity in healthcare and we have health for all. In contrast to the US, people don’t die in our countries because they cannot afford to pay for their insulin, hospital stay or insurance.

References

1 UK Government. Landmark UK-US pharmaceuticals deal to safeguard medicines access and drive vital investment for UK patients and businesses. Press release 2025;Dec 1.

2 Cross S, Claxton K, Hill A. Health costs of the UK-US trade deal on pharmaceuticals. BMJ 2026;394:e340588.

3 Abbasi K. £45bn and 300 000 deaths: the UK’s anniversary gift to the US. BMJ 2026;394e100179.

4 Bush D. From Truman’s pension to Trump’s billions - a White House windfall unmatched by any president. BBC 2026;July 2.

5 Gøtzsche PC. In Greenlandic, MAGA means Make America Go Away. Trump’s grandiosity complex, lawlessness and narcissism have united the whole world against America. Gøtzsche’s Perspective 2026;Jan 30.

6 Pandey M. Trump reverses threat of 20% fee on Strait of Hormuz cargo as US prepares to resume Iran ports blockade. BBC 2026;July 13.

7 Gøtzsche PC. Deadly medicines and organised crime: How big pharma has corrupted health care. London: Radcliffe Publishing; 2013.

8 Gøtzsche PC. Patients not patents: Drug research and development as a public enterprise. Eur J Clin Invest 2018;48:e12875.

9 Gøtzsche PC. A totally new system is needed for drug research and development. Eur J Clin Invest 2018;48:e12883.

10 Gøtzsche PC. Prescription drugs are the leading cause of death. And psychiatric drugs are the third leading cause of death. Mad in America 2024;April 16.

11 Ghosh R, Ross JS. US healthcare gap is growing. BMJ 2026;393:e100043.

12 Brownlee S. Overtreated: why too much medicine is making us sicker and poorer. New York: Bloomsbury; 2007.

13 World Health Report 2003 – shaping the future. World Health Organization 2003.

14 Reinhardt UE, Hussey PS, Anderson GF. U.S. health care spending in an international context. Health Aff (Millwood) 2004;23:10-25.

15 Roehr B. Health care in US ranks lowest among developed countries, Commonwealth Fund study shows. BMJ 2008;337:a889.

16 Starfield B, Shi L, Grover A, Macinko J. The effects of specialist supply on populations’ health: assessing the evidence. Health Aff (Millwood) 2005; Jan-Jun;Suppl Web Exclusives:W5-97-W5-107.

17 Wealth but not health in the USA. Lancet 2013;381:177.

18 Nolte E, McKee CM. Measuring the health of nations: updating an earlier analysis. Health Aff (Millwood) 2008;27:58–71.

19 Avendano M, Glymour MM, Banks J, et al. Health disadvantage in US adults aged 50 to 74 years: a comparison of the health of rich and poor Americans with that of Europeans. Am J Public Health 2009;99:540–8.