title: Vulnerability of health to market forces.
abstract: OBJECTIVE
  This article reviews adverse influences of for-profit enterprises on health care and public health, and examines significance for public policy.
  
  
  METHODS
  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.
authors.affiliation: Center for Bioethics, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA. mbrezis@gmail.com
authors.forename: Mayer
authors.initials: M
authors.lastname: Brezis
authors.forename: William H
authors.initials: WH
authors.lastname: Wiist
mesh_terms: D003695:Delivery of Health Care / Q000191:economics; D004345:Drug Industry / Q000191:economics; D017048:Health Care Costs; D019981:Health Care Sector / Q000191:economics*; D006801:Humans; D008389:Marketing of Health Services; D011057:Politics; D011634:Public Health; D011640:Public Policy; D011787:Quality of Health Care; D014481:United States