There are at least 15 points of intervention by the pharmaceutical industry in the causal pathway from a TV ad to a prescription. Ghost-managed medicine exposes Big Pharma’s calculated control of this pathway. Many of the interventions might appear to come from outside industry with contributions from seemingly independent researchers, medical experts, regulators and consumer organisations. But it is all carefully and ruthlessly orchestrated by industry; egregious examples from the United States include the Orwellian “patient advocacy” group, Centre for Medicine in the Public Interest, created as a voice for Big Pharma and controlled by it.