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Vulnerability of Health to Market Forces

Brezis, Mayer MD, MPH*; Wiist, William H. DHSc, MPH, MS

doi: 10.1097/MLR.0b013e31820ab638

Objectives: This article reviews adverse influences of for-profit enterprises on health care and public health, and examines significance for public policy.

Research Design: Narrative review.

Results: For-profit health-care industries may increase costs and reduce quality, leading to market failure and contributing to the USA's unflattering position in international comparisons of health-care efficiency. Drug and device corporations use strategies such as making biased inferences, influencing scientists and physicians, marketing rather than informing the public, and lobbying to control their own industry regulations to create market advantage. Successful marketing leads to the increased use of costly profit-making drugs and procedures over cheaper, nonpatented therapies. Because resources are limited, the overuse of costly modalities contributes to expensive health care, which presents a challenge to universal coverage. The free market also fosters the proliferation of industries, such as tobacco, food, and chemicals, which externalize costs to maximize profits, seek to unduly influence research by paying experts and universities, and attempt to control the media and regulatory agencies. Most vulnerable to the cumulative harm of these tactics are children, the poor, the sick, and the least educated.

Conclusions: The free market can harm health and health care. The corporate obligation to increase profits and ensure a return to shareholders affects public health. Such excesses of capitalism pose formidable challenges to social justice and public health. The recognition of the health risks entailed by corporation-controlled markets has important implications for public policy. Reforms are required to limit the power of corporations.

From the *Center for Bioethics, Brigham and Women's Hospital & Harvard Medical School, Boston, MA; and †Department of Health Sciences, Northern Arizona University, Flagstaff, AZ.

This article was written during a sabbatical year at Harvard and at Stanford.

Mayer Brezis is currently at Center for Clinical Quality & Safety, Hadassah Hebrew University Medical Center, Jerusalem, Israel.

Reprints: Mayer Brezis, MD, MPH. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.