Health care, U.S.-style, increasingly has to do with markets and money. The suffering of the poor and excluded are back-burner items. The pharmaceutical industry, which is presently on a roll, provides ample evidence of what happens when profits come first and human needs second.

Basic vaccines, for example, are now in short supply, mainly because of production cuts. Children are leaving clinics and medical offices, my own pediatric office included, unable to obtain necessary immunizations against disastrous infectious diseases, specifically measles, rubella, diphtheria, tetanus and whooping cough.

Since the advent of scientific medicine, childhood – and adult – immunizations have been a mainstay of preventative care,. U.S. immunization rates still lag behind those of other industrialized nations, even behind the poor country of Cuba, where immunization rates approach 100 percent. By 2000, public health efforts had pushed rates among U.S. children aged 19 to 35 months up to between 81 percent and 94 percent, depending on the vaccine. Now, with immunizations being postponed, backsliding is inevitable.

Dr. Philip A. Brunell. editor of Infectious Diseases in Children, discussed these shortages in the May issue: “You can be sure it’s about money … There are very few things in medicine that can compare with immunizations for cost effectiveness. They are generally less profitable than the billion-dollar blockbusters for which pharmaceutical companies strive … Discontinuing the manufactured vaccine products … is a trend that has continued through the years. In 1967, when there were far fewer vaccines, there were 26 manufacturers; now there are 12. A variety of reasons have been offered for the shortage … However, it still comes down to the bottom line.”

Nor are vaccine shortages confined to the United States. According to Carol Bellamy, director of the United Nations Children’s Fund (UNICEF), “These shortages affect virtually every category of traditional vaccines given to children in poor countries. Immunizations save approximately 3 million lives each year, but another 3 million lives are lost because children do not have access to basic vaccines … The growing shortage of supply will … lead to more illness, disability and death.” She blames the vaccine manufacturers for their emphasis on profit-making drugs and vaccines. UNICEF notes that 10 out of 14 vaccine makers have reduced or stopped production of traditional vaccines.

What might the drug companies be up to as they weaken efforts to prevent epidemic infectious diseases? GlaxoSmithKline, based in Britain, has recently induced the Food and Drug Administration (FDA) to undo restrictions placed on its product, Lotronex, in November 2000 because of reports of intestinal complications and several deaths. Prescribed for irritable bowel syndrome, the drug at its peak was being used by 275,000 people. At a monthly cost per patient of $175, the annual yield was $577,500,000. The drug now returns to use, profit and possible calamity, on the condition that the company instructs and certifies the physicians prescribing it. The monthly cost to patients will go up, as did the price of company shares on the London market once the good news was out.

Then there is the story of payments by the Genentech Corporation of over $11 million, made over a decade to the American Heart Association, including $2.5 million for the Association’s new headquarters in Dallas. Genentech makes alteplase, a drug that breaks apart blood clots and is used for people with strokes. Given early, alteplase is supposed to prevent or lessen brain damage. Because of outcome studies that were equivocal, the American Heart Association, in its first recommendations for physicians, designated altepase as “optional.” Later alteplase was moved to the “definitely recommended” category, despite continued scientific uncertainty. Of the nine physicians on the association panel that changed the recommendation, six had monetary ties to Genentech. The lone dissenter had none.

These are stories of greed, bribery and callousness toward the sick and dying. Two lessons emerge, neither one of them surprising. Businesses operating in the health care realm are no more likely to have altruistic motives than businesses anywhere. And the tendency of the medical profession to remain quiet in the face of horrors like these speaks of ethics gone awry.

In a market-based economy all that is asked of corporations is that they make a profit. Just plain citizens, however, can aspire to something more: preventable diseases eliminated, health care for all, the certainty of human survival, and a world where ideals of fairness and dignity prevail. The prospect of realizing aspirations like these under capitalism is, of course, remote. Compromise and putting off may be required of activists fighting for universal health care, but they would do well to remember that socialism is still their ultimate goal.

W.T. Whitney is a pediatrician in Maine. He can be reached at