Martin Shkreli, former CEO of Turing Pharmaceuticals, is best known for jacking up the price of Daraprim, a decades-old toxoplasmosis drug used by about 3,000 patients a year.

Shkreli is young, brash, and easy to mock. During recent congressional hearings, some lawmakers took aspecial delight in asking him questions about the $2 million Wu-Tang Clan album he purchased, much as I expect they act when demanding answers of their unruly teenagers. He gleefully uses Twitter and livestreams his days. He does not toe the pharmaceutical party line.

See also: Finding a Better Strategy for Pricing Drugs

Drugmakers have long insisted R&D spending pressures them to charge the prices they do even as they push back against calls to change those pricing strategies and resist legislative proposals to make those practices more transparent. Documents turned over to a House committee showed that Turing’s primary motive, unsurprisingly, for the price increase was profit.

The CEOs of other drugmak­ers have questioned Shkreli’s ethics and attitude and have de­scribed his pricing practices as outliers. Yet price hikes of older drugs have occurred time and again, at many firms, for years, and I don’t expect them to stop, just as I don’t expect new drugs to be priced lower than expected.

Now, this criticism and contempt for pharmaceutical pricing and marketing practices go beyond damaging the perception of drug companies and their CEOs.

The pricing debate has been intensifying for years. That’s nothing new. What has changed, however, is the extent to which criticism of these so-called bad actors has extended to other players in the pharmaceutical sector, including ad agencies.

A House Democrat in February introduced a bill that would ban DTC advertising for three years after a drug receives FDA approval unless it is recognized as benefiting public health. And, in his speech at the Medical Advertising Hall of Fame’s annual dinner in February, Scott Cotherman, former CEO of Corbett, singled out Shkreli, accusing him of putting profits before patients.

The industry Cotherman knows is one “where pharmaceutical industry leaders were not afraid to speak up to fight for what was right and in the patient’s best interest without the fear of circus-like congressional hearings designed to further erode the public’s trust in our profession.”

Exactly how does the erosion of public trust in the goodwill of the pharma industry impact the work being done to raise awareness and also market medicines? It’s hard to tell, so far. But skepticism often follows the erosion of trust. Cynicism comes next.

Jaimy Lee is executive editor of MM&M.