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I think it's also important to say that no one that accepts the efficacy of vaccines or that rolls their eyes at the phrase "big pharma" would say that the industry is without fault or could not be improved. That's the false dilemma that some seem to try to characterize the discussion with (even in this thread); if I don't reject big pharma then I think private companies and governments are perfect and can be totally trusted. Reality is far more nuanced.

There's lots that could be done to improve how things are done, especially in the area of studies and trials.

I've read some of Ben Goldacre's Bad Pharma which was very interesting. I took it with a grain of salt, but Goldacre's history is pretty good and a lot of his suggestions in the area were quite reasonable.