Advances in Applied Sociology
2012. Vol.2, No.4, 237-244
Published Online December 2012 in SciRes (http://www.SciRP.org/journal/aasoci) http://dx.doi.org/10.4236/aasoci.2012.24031
Profit from Sickness: The Case of Technology-Driven Healthcare
Suman Hazarika1, Akhil Ranjan Dutta2
1Department of Radiology, International Hospital, Guwahati, India
2Department of Political Science, Gauhati University, Guwahati, India
Received July 26th, 2012; revised August 29th, 2012; accepted September 13th, 2012
The increasing corporatization and growing dependence of the healthcare system on technology has
brought about a radical transformation to the entire mission of the healthcare system. Based on the profit
motive, the pharmaceutical and technological enterprises that hugely control the healthcare system today
have so transformed the system that it has now emerged as one of the most profiteering domains. The
historical tragedy is that the profit is earned over sickness. There has indeed been an attempt to generate
sickness as demanded both by health care devices as well as by the pharmaceutical industries having det-
rimental impact on people’s right to health. Present paper, which critically questions the logic and motives
of the emerging healthcare system, argues that under the contemporary neo-liberal economies, diseases
and patients are objects of business interests of the largely privatized for-profit healthcare industry. Profit
from these objects emerges not only through sale of drugs or cure, but also from expensive hi-tech testing
and “treatment” technologies. Creation of new patients by diagnosing more diseases to treat is contributed
by a large medical-industrial complex today. The paper is of the view that remedies to these crises de-
mand radical a U-turn to the system itself wherein the health care seekers rather than the health care pro-
viders would occupy the center stage.
Keywords: Epidemics; Pharmaceutical Industry; Medical-Industrial Complex; Mass Killer; Cocktail
Vaccines
Introduction
Concerned with less than adequate quality of medical educa-
tion and the consequent degradation of the healthcare system of
America, in the early part of 20th century, Abraham Flexner, an
educationist, was commissioned by the Carnegie Foundation to
systematically review the state of medical education in the
American continent. After a thorough study and visit to all the
medical schools of the United States of America and Canada,
he submitted a report in 1910. His 1910 report, Medical Educa-
tion in the United States and Canada, is a classic work often
cited for its importance even today. Flexner’s report fueled
change by criticizing the mediocre quality and profit motive of
many schools and teachers, the inadequate curricula and facili-
ties at a number of schools, and the non-scientific approach to
preparation for the profession (Cooke, Irby, Sullivan, & Lud-
merer, 2006). Based on Flexner’s observation, a massive shift
in the ways of medical education had ensued and over the next
few decades, the medical education system evolved into one of
the finest in the world. However, one of the concerns expressed
in Flexner’s observation on the medical education and health-
care system regarding the motive to profit affecting its quality
seems to persist even after a century. Current scenario in the
healthcare system has precipitated pressure on physicians to
increase their clinical productivity; that is, to generate revenues
by providing care for paying patients. Mounting clinical chores
leave less time for the academic pursuit of the medical sciences.
Market-driven economy has brought in the health administra-
tors and managers to manage the for-profit healthcare system.
Changing the care delivery system to an industry that sales its
service, nevertheless, has created its own evils. Today, health-
care managers think in terms of “patient throughput”, “market
share”, “bed occupancy”, “wait time”, “utilization rate”, and
finally, “return on investment”. It has become a culture of
business rather than a culture of service.
In a world polarized by economic divide, health care facili-
ties are built by entrepreneurs to earn money. Today, giant
pharmaceutical corporations are some of the most profitable
companies with unimaginable power over the healthcare system
and people. It is time to see how healthcare has evolved into an
industry seeking big profits at any cost.
Perspective on Being Sick and Sickness of Body
In the contemporary neoliberal economies, diseases and pa-
tients are objects of business interest of the largely privatized
for-profit healthcare industry. Profit from these objects emerges
not only through sale of drugs or cure, but also from expensive
hi-tech testing and “treatment” technologies. Creation of new
patients by diagnosing more diseases to treat is contributed by a
large medical-industrial complex of diagnostic technologies
such as the expensive CT scan, MRI, ultrasound equipment,
and more sophisticated and evolving laboratory medical tech-
nologies like molecular diagnostics, electron microscopy so on
and so forth.
While technology-driven modern medical care tends to ana-
lyze the functionality of bodily organs to repair or restore them
to the best possible level, it also reduces the human being into
biological machines in need of repair.
Evolution of Medical-Industrial Co mpl e x
In 1980, Relman in his essay on medical-industrial complex,
argued that silent rise of investor-owned businesses was taking

S. HAZARIKA, A. R. DUTTA
over large parts of a health system, which until then had been
largely community-based and not-for-profit (Relmam, 1980).
The constituent of the system included proprietary hospitals and
nursing homes, diagnostic laboratories, home care and emer-
gency room services, and hemodialysis centers. Relman has
cited similarity of the healthcare system to the “military-in-
dustrial complex” that Dwight Eisenhower had warned about in
his farewell address as US president in 1961. The expression
“new medical-industrial complex” was coined by Relman, and
today it is in popular use. This new medical-industrial complex
may be seen as more efficient than its nonprofit competition,
but it also has the serious problem of overuse and fragmentation
of services, overemphasis on technology, and undue influence
on health policy. In his 1997 paper Market for healthcare:
where is the patient? Relman observes, “Markets may be effi-
cient ways of distributing goods and services to those who can
afford them, but they are quite indifferent to the needs of the
poor and underprivileged”. There is increasing presence of
for-profit players in the healthcare system and unless the medi-
cal-industrial complex is regulated properly, a people friendly
system based on compassion and need cannot be built. Relman
has expressed his concern in this regards, “··· new medical-
industrial complex defined to include the entire range of busi-
nesses concerned with the delivery of health services, probably
now accounts for at least 50% of total national (American)
expenditures on personal healthcare. It is undoubtedly the most
powerful element shaping our health care system today. No
significant reform can be expected in the future without regula-
tion of the market forces now dominant in that system.” (Rel-
man, 1997).
Based on his study of the American healthcare system, Paul
Starr, in 1982, predicted the reduction of public healthcare sys-
tem by the evolving corporate health industry in his book titled
Social Transformation of American Medicine (Starr, 1982). His
prediction was that, “Instead of public regulation, there will be
private regulation, and instead of public planning, there will be
private planning. Instead of public financing for prepaid plans
there will be corporate financing for private plans controlled by
conglomerates whose interest will be determined by the rate of
return on investments”.
Geyman, in 2003, in a paper titled Corporate Transformation
of Medicine and its Impact on Cost and Access to Care, has
commented that the full impact of the medical-industrial com-
plex over American healthcare system has been obvious with
increasing cost of health care, over dependence on technology
and inefficiency (Geyman, 2003). Geyman observed that for
investor-owned health care corporations, money is the mission,
not the public interest. The flaws of an unregulated market
system have been exposed, but lamentably, public and profess-
sional understanding of these issues is not forthcoming.
Rising Health Care Cost: Rising Pr o fit f ro m
Sickness?
In 1986, the Institute of Medicine published its study on for-
profit enterprises in health care that focused primarily on the
behavior of investor-owned acute care hospitals (Gray, 1986).
The highlights of the study were that investor-owned hospitals
increased health care costs to the payers; these establishments
provided less charity care and were not any more efficient than
not-for-profit hospitals.
There are comparative studies trying to understand difference
in standard of care between private for-profit medical facilities
versus state-owned nonprofit facilities. In the cases of chronic
kidney disease or end stage kidney disease, modern dialysis
technique extends life span. Dialysis, per say, is an expensive
and high-end technology that maintains internal chemistry of a
person whose kidneys are not working properly. Reliable stud-
ies reveal that death rates differ in profit seeking versus non-
profit enterprises that provide dialysis care for end stage renal
disease. The New England Journal of Medicine in 1999 carried
an article titled Effect of ownership of dialysis centres on pa-
tient survival (Garg, Frick, Diener, & Powe, 1999). It was seen
in this study on 3569 patient with end stage renal disease that
crude mortality rate per 100 person-years was 21.2 in for-profit
facilities, as compared to 17.1 in not-for-profit facilities. It was
further seen that even after adjusting the variables of the patient
etc. treatment in a for-profit facility continued to be associated
with higher mortality rate.
In a meta-analysis published in the Journal of American
Medical Association in 2002 about dialysis facilities, it was
concluded that mortality rates are higher in private for-profit
dialysis centers than the nonprofit dialysis units. The authors
identified lack of adequate work force and reduced length of
dialysis time as the chief culprits that had a negative effect on
patients. Profit motives of private for-profit centers resulted in
these flawed practices (Devereaux, Schünemann, Ravindran,
Bhandari, Garg , Choi et al., 2002).
Reduction of hemoglobin (anemia) in chronic kidney disease
is a recognized phenomenon. The introduction of recombinant
human erythropoietin (epoetin)1 in 1989 significantly improved
the clinical management of anemia in cases of the end-stage
kidney disease. This drug is very costly and it is found to be the
largest single Medicare drug expenditure totaling $1.8 billion in
the USA in 2004 (United States Renal Data System, 2006). It
was found that for-profit facilities administered smaller doses
of epoetin compared with nonprofit facilities, due to the cost of
the medicine in the early days. Once epoetin payment has been
based on the amount of drug administered creating a financial
incentive for increased use of this therapy, it was seen that the
use of this drug started to increase. Thamer et al. in 2007 pub-
lished a study titled Dialysis Facility Ownership and Epoetin
Dosing in Patients on Haemodialysis in the Journal of Ameri-
can Medical association (Thamer, Zhang , Kaufman, Cotter,
Dong, & Hernán, 2007). This study suggested a profit motive in
deciding drug dosing in end-stage kidney disease patient. The
researchers included adult Medicare eligible end-stage renal
disease patients receiving in-center hemodialysis during No-
vember and December 2004. Regression models were used to
estimate the mean epoetin dose and dose adjustment by profit,
chain, and affiliation status. The study included 28,199 patients
from nonprofit dialysis centers and 159,522 patients from the
for-profit dialysis centers. The study documented consistently
higher dosing of epoetin in the for-profit centers. In the con-
cluding remark, the authors commented that dialysis facility
organizational status and ownerships are associated with varia-
tion in epoetin doses in United States. The researchers put the
final comment to highlight the need for a rational reimburse-
1Erythropoietin is normally produced by kidneys, and they regulate blood
hemoglobin. Kidney diseases alter the balance of erythropoietin and hemo-
globin production. It is a medical practice now to use erythropoietin pro-
duced artificially by recombinant DNA technology to regulate the hemo-
globin levels in patients of chronic kidney disease. Epoetin is one of the
commercially produced erythropoietin.
238

S. HAZARIKA, A. R. DUTTA
ment policy that provides an incentive to achieve desired clini-
cal outcomes while optimizing epoetin usage.
It is not very difficult to imagine that in the dominant capi-
talist world economy, there is an ever-increasing cost escalation
in providing health care due to cost of technology. In today’s
technology dominant health care delivery, the act of medical
diagnosis and treatment of illness is increasingly seen as big
business. Sick bodies are objects of exploitation for the promo-
tion of new medical drugs and technologies. To support our
conjecture of big business, we cite the interesting statistics in
Table 1, which is detailing the annual revenue and profits of
the big pharmaceuticals company in the years of 2006, 2008,
2010. All these companies consistently figured in the Fortune
magazine’s list of top companies (Fortune Magazine, April
17th 2006, May 5th 2008 and May 3rd issues of 2010).
The pharmaceutical industry argues that its high drug prices
are necessary for innovation and development of new drugs, but
the evidence is overwhelming that unrestrained profiteering has
been the rule for many years. A further look at the profit versus
expenditure incurred for new developments and research is
necessary at this point. We are presenting the research and de-
velopment cost as a percentage of the revenue of the few big
pharmaceutical industries in Table 2, based on their annual
reports from the archive (Fortune 500 database of 50 years) and
published reports (Davidson & Greblov, 2005).
The R&D costs as fraction of the revenue earned appear to
be acceptable in a superficial look, but it is deceptive to accept
at face value. One needs to be critical in approaching the data
on R&D cost based on the fact that relatively low number of
actual new molecules or active drugs are invented out of these
research activities compared to combination products or varia-
tions in the existing blockbuster drugs. In the USA, the entry of
a new drug to the market is strictly regulated by the Food and
Drug Administration (FDA). In their May 2002 report, National
Institute of Healthcare Management cites the interesting statis-
tics from the FDA records about new drug approvals (NIHCM,
2002). Between 1989 and 2000, the FDA approved 1035 new
drug applications. Of these, 361 or 35% were for actually new
active ingredients. In the same period, 65% medicines were
approved that were already available and marketed products.
Table 1.
Comparison of revenue, profit and profit as percentage of revenue in 2006, 2008, and 2010 of six fortune 500 pharmaceutical companies.
Company Name
Revenue & Profit in Million $
Johnson & Johnson Pfizer Merck Bristol Meyer’s Squibb Wyeth Eli Lilly
2006
Revenue Total
Profit Total
Profit as % of Revenue
50,514
10,411
21%
51,353
8085
16%
22,012
4531
21%
20,222
3000
15%
18,756
3656
20%
14,645
1980
14%
2008
Revenue Total
Profit Total
Profit as % of Revenue
61,095
10,576
17%
48,418
8144
16.8%
24197.7
3275.4
13.5%
19977.7
2165
10.4%
22399.8
4616.0
20.6%
18633.5
2953.0
15.8%
2010
Revenue Total
Profit Total
Profit as % of Revenue
61,897
12,266
19%
50,009
8635
17.3%
27428.3
12901.3
47%
21,634
10,612
49.1%
Not Available 21,863
4328.8
19.8%
Table 2.
R&D costs and profit of pharmaceutical industry as percentage of total revenues.
Year
Company Name R&D Expenditure and Profit
2002 2003 2004
Pfizer R&D Cost as % of Revenue
Profit as % Revenue
16.1%
24.1%
16.7%
25.9%
14.6%
8.5%
Johnson & Johnsons R&D Cost as % of Revenue
Profit as % Revenue
10.9%
17.2%
11.2%
18.2%
11%
17.4%
Merck R&D Cost as % of Revenue
Profit as % Revenue
5.2%
15.3%
14.6%
13.8%
17.5%
30.4%
Bristol Meyers Sqibb R&D Cost as % of Revenue
Profit as % Revenue
12.2%
24.2%
10.9%
10.5%
12.9%
14.3%
Wyeth R&D Cost as % of Revenue
Profit as % of Revenue
14.3%
16.2%
13.2%
30.5%
14.2%
12.9%

S. HAZARIKA, A. R. DUTTA
Similarly, from 1989 to 2000, the FDA gave a priority review
to 24% of new drug applications that appeared to be of impor-
tance due to the fact they were possibly improvements on ex-
isting therapy. FDA data is a clear indication to the direction of
research in pharmaceutical industry. We shall further argue in
our paper about negligence of the “poor men disease” where
little research funding is spared because possible profit from
these research is considered to be low. In reality, much of the
R&D is devoted to repackaging or recombining already avail-
able or invented drugs rather than spending a fortune on possi-
bility of finding cure for yet to be treated diseases. There is no
doubt that new drug design and development is a long arduous
procedure, which will be following long routes of phased clini-
cal trials before being released to the market, but one cannot
deny the fact that even if the costs to treat is high and process is
arduous, we need to focus on many of the tropical diseases
affecting the so-called developing nations. There cannot be
denial of health and life based on cost involved in research and
production to the marginalized poorer nations of the world. The
drug industry has the responsibility to fund more research into
low cost solutions of various infective diseases that affect the
developing nations.
In 1950, Senator Estes Kefauver headed the United State’s
Anti-Trust and Monopoly Subcommittee to examine the busi-
ness model of the pharmaceutical industry. Kefauver brought in
the charge of predatory drug prices and excessive margins of
the pharmaceutical industry that is born by the patient
(Kefauver, 1965). The next two important charges were con-
cerning the extravagant expenditures in marketing that drives
cost of medicine and introduction of not so effective newer
products. Since then, there have been continuing debates on
excess profit versus research expenditures of the drug manu-
facturing industry. There have been counter views from the
industry sides showing more cost in R&D than their expendi-
ture on marketing, but the methods of accountings are complex.
Researchers have continued to examine the marketing and
promotional expenditures from various business intelligence
reports and published annual reports to examine the issue of
massive promotional expenditures against reduced R&D budget.
Gagnon, M. A. (2008) remarked in the final conclusion of the
study titled “The Cost of Pushing Pills: A New Estimate of
Pharmaceutical Promotion Expenditures in the United States”,
“··· numbers clearly show how promotion predominates over
R&D in the pharmaceutical industry, contrary to the industry’s
claim. While the amount spent on promotion is not in itself a
confirmation of Kefauver’s depiction of the pharmaceutical
industry, it confirms the public image of a marketing-driven
industry and provides an important argument to petition in fa-
vor of transforming the workings of the industry in the direc-
tion of more research and less promotion.” (Gagnon & Lexchin
2008).
While the pharmaceutical industry has been identified as a
big spender in advertising and promotional activities millions
are left waiting for a cure to be found for various neglected
tropical disease. In 2002, the Fortune 500 pharmaceutical com-
panies spent nearly 30.8% of their revenue in advertising and
marketing in contrast to 14.1% on R&D activity (Public Citizen,
2003). The question what is being researched and for whom it
is being researched needs to be answered too. In terms of total
corporate expenditure, sales and marketing account for the
greatest corporate expense and rose from 28.7% to 33.1% of
expenditure between 1995 and 2005 (Johnston, Moss, & Brown,
2011).
A historical review of changing values illustrates the rising
profit motives from sickness. In the bygone days of global polio
epidemics, Jonas Salk & Albert Sabin discovered the polio
vaccines in the 1950s, and the world avoided a huge number of
polio deaths. Polio is being eradicated today, and the inventor
duo of the vaccine refused to patent the vaccine for earning
their share of profit, made it a gift to humanity. The idea of
earning profit from a discovery to treat a disease was alien to
them!
Stomach ulcer, as we all call it, was being treated by costly
medicines that were used to treat the pain and symptoms, far
from curing the ulcer itself. Barry Marshall discovered a bacte-
rium called H. pylori that causes the stomach ulcer in 1984, but
nobody bothered to treat ulcers with antibiotic for another dec-
ade. Dr Marshall’s initial claim of bacteria causing stomach
ulcer was initially not accepted by the fraternity. Dr Marshall
was unable to make his case in studies with lab mice (because,
H. pylori affects only primates) and prohibited from experi-
menting on people, Dr. Marshall grew desperate. Finally, he ran
an experiment on himself. He infected himself by taking H.
pylori from the gut of an ailing patient, stirred it into a broth,
and drank it. After 10 days, he biopsied his own stomach and
found H. pylori proving unequivocally that bacteria were the
underlying cause of ulcers. In an interview Dr Marshall com-
mented, “In fact, our letters (to Lancet Magazine) were so
weird that they almost didn’t get published. By then, I was
working at a hospital in Fremantle, biopsying every patient who
came through the door. I was getting all these patients and
couldn’t keep tabs on them, so I tapped all the drug companies
to request research funding for a computer. They all wrote back
saying how difficult times were and they didn’t have any re-
search money. But they were making a billion dollars a year for
the antacid drug Zantac and another billion for Tagamet. You
could make a patient feel better by removing the acid. Treated,
most patients didn’t die from their ulcer and didn’t need surgery,
so it was worth $100 a month per patient, a hell of a lot of
money in those days. In America in the 1980s, 2 to 4 percent of
the population had Tagamet tablets in their pocket. There was
no incentive to find a cure.” (Weintraub, 2010). The powerful
industries making huge profits from ulcers were simply not
interested in curing their customers (patients) if it meant losing
their margins of profits. In 1997, massive government cam-
paigns were needed to popularize treatment of stomach ulcers
with a short course antibiotic that is cheaper than treating the
symptoms by costly drugs for years. The very fact that the
medical-industrial complex neglected a discovery that produces
effective and cheaper cure for stomach ulcers for nearly 15
years, prompts us to raise questions regarding motive of the
medical-industry.
The story of H. pylori and stomach ulcer is cited to drive
home the point that corporate health industry might not act on
the best interest of a patient, if it affects their profit from sales
of existing products. It is entirely possible to suppress useful
research findings. How do we know today that a cheaper treat-
ment method or therapy for a mass killer like HIV or cancer has
not already been invented? Can we trust the medical industry to
sacrifice profit and investments to encourage treatments that
can make the current costly drugs redundant? Will such an
invention reach the public immediately, or is there a possibility
of hiding facts concerning new developments? Will the medi-
cal-industry complex suppress and brush aside the genuine
240

S. HAZARIKA, A. R. DUTTA
claims, or find complex arguments to banish newer alternatives
as was done for the cure of stomach ulcer?
These are very powerful thoughts centering the very idea of
building a healthcare system to earn profit. One should reflect
on the possibility of such enterprises maximizing profit and
minimizing health of the people.
HIV and the Fallout: Re ducing Cost of Big Ph arma
Products by Generic Drugs
AIDS epidemic has successfully recruited human endeavor
for profit too. Like all other global diseases, HIV created op-
portunity to make the big profit. In 2007, drug major Gilead
made $1194 million sales turnover from selling Truvada—a
drug for HIV, which was a whopping 210% climb from their
2005 sales. Table 3 presents the worldwide sales turnover of a
few important anti-AIDS medications (Treatment Action Group,
2007).
The high prices of AIDS drugs started the worldwide debate
in the socio-political circles. Dr. Nathan Ford, in his 2003 Brit-
ish Medical Journal essay, cites Dr. Chris Ouma of Kenya,
where 2.5 million people are infected with HIV, and most of
them cannot afford AIDS drugs, “The doctor’s role goes from
caregiver to undertaker. You talk to them about the cheapest
method of burial. Telling them about the drugs is always kind
of a cruel joke.” (Ford, 2003).
The global epidemic of HIV and AIDS have seen lots of po-
litical activism and participation of the public to debate the
issues of high cost of treatment of HIV infection and the possi-
ble consequence of an pandemic. Because of public outrage,
big pharmaceutical companies agreed on differential pricing of
HIV drugs for the low-income countries and gave birth to ge-
neric drugs. Cipla, an Indian pharmaceutical company, started
to produce generic anti-retrovirals that were the same as those
made by large pharmaceutical companies, but significantly
cheaper due to lesser expenses related to research and devel-
opment. Generic drug created a price war that forced the large
pharmaceutical companies to lower the price of their AIDS
drugs. Generic drug started a new race in the game to protect
the interests of the big pharmaceutical companies. They argued
that without a patent to their researched drug or product, they
could not sustain the research activity to discover new drugs or
devices, let alone send them for multistage clinical trials. A
drug patent typically lasts for 20 years.
Table 3.
Anti-HIV drug sales volume of top companies in 2006.
Drug Company
Sales Volume
in Million $
Change from
2005
Truvada Gilead 1194 +210%
Kaletra Abbott 1135 +13%
Combivir GlaxoSmithKline 977 −8%
Reyataz Bristol-Myers
Squibb 931 +34%
Sustiva Bristol-Myers
Squibb 791 +16%
Epzicom GlaxoSmithKline 446 +207%
The pharmaceuticals companies exert massive political in-
fluence to protect their profit (Abraham, 2002). In 2001, a coa-
lition of 39 major pharmaceutical companies attempted to
prosecute the Government of South Africa, for passing a law
that allowed easy production and importation of generics.
However, huge outcry from the international community in-
cluding the South African government, the European Parlia-
ment and 300,000 people from over 130 countries who signed a
petition against the action, forced the pharmaceutical industry
to refrain from such an adventure. One of the pharmaceutical
companies involved in the case, GlaxoSmithKline, even
granted “voluntary license” to major South African generics
producer Aspen to share the rights to their anti-retroviral drugs.
This was a significant case as it brought access to medicines for
poor countries into the public consciousness.
Selling Fear of Sickness: Profit from Disease
Mongering
The old dictum of “health is wealth” is literally true for profit
seeking healthcare industries. There is opportunity to earn big
profit even from people who are not sick and are in good health.
The social construction of disease as a state of temporary
physical or mental condition is being replaced by corporate
construction of health as a state of life full of positive energy,
desire and fulfillment. The profit seeking industry has learned
that there is money to be made in preservation or promise to
preserve positive health.
It is now evident that even healthy people are ready to spend
money if they can be educated on potential risks of disease and
by medicalization of physiology. Medicalization of childbirth
has been a real money-spinner for the industry. From the initial
confirmation of pregnancy through the event of screening,
checkups, and finally, hospitalized childbirth till post partum
care has given childbirth the status of the most money making
enterprise for the medical industry. To justify better health care
by active operative intervention by caesarean delivery method
is not acceptable. World over, the rates of caesarean delivery is
going high, and in 2009 in the US the rate was 32.3 % of all
live births (National Vital Statistics Report, 2011). Though
there are newspaper reports regarding profit motives in in-
creasing the number of caesarean sections, but systematic re-
search to nonclinical factors are usually not undertaken. In a
study titled The Role of Nonclinical Factors in Cesarean Sec-
tion Rates in Brazil by Hopkins and Amaral carried out at Uni-
versity of Texas at Austin on pattern of child delivery and op-
erative interventions in Brazilian women, some very interesting
points were made (Hopkins & Amaral, 2005). The study evalu-
ated the 1998 Brazilian census data to arrive at the results. Bra-
zil has one of the highest caesarean section rates (37%) in the
world. It was seen that extraordinarily high rates of above 70%
in private for-profit hospitals contrasted sharply with the
not-for-profit public hospitals where the rates were in the 20%
to 30% range. To analyze various factors like income, educa-
tion, etc., a multivariate analysis of factors were done in this
study, which came out with the conclusion that the nature of
organization where a women delivers is the strongest predictor
of whether it will be a surgical delivery or not, regardless of her
individual characteristics. Ghosh, in 2010, studied the increas-
ing trend in caesarean section delivery in India and role of
medicalization of maternal health to infer various factors de-
ciding mode of childbirth (Ghosh, 2010). The conclusion drawn

S. HAZARIKA, A. R. DUTTA
was that apart from access to better healthcare system and in-
stitutional child delivery facilities, nonclinical factors like
medicalization of childbirth, educational and socio-economic
status of women are emerging as determinants of mode of
childbirth.
Medicalization of aging, physiology and normal phenome-
non to earn profit have other examples. Medicalization of
baldness is one interesting example. Around the time Merck’s
hair growth drug finasteride (Propecia) was first approved in
Australia, leading newspapers featured new information about
the emotional trauma associated with hair loss.
A key strategy of the industry is to use the media with stories
designed to create fears about the condition or disease and draw
attention to the latest treatment. The sponsoring company pro-
vides “independent experts” for these stories, consumer groups
provide the “victims”, and public relations companies provide
media outlets with the positive spin about the latest “break-
through” medications (Moynihan, Heath, & Henry, 2002).
Physiological loss of bone mass in elderly women is a risk
factor for fractures, but it is definitely not a disease. Pharma-
ceutical industry is now putting its full effort to turn this risk
factor in to a full-fledged disease telling that it needs certain
preventive treatment. A medical foundation on osteoporosis,
which has received funding from pharmaceutical companies,
issued a press release urging people to take a one minute test
for the risk of osteoporosis, “we call this disease a silent thief:
if you’re not vigilant, it can sneak up on you and snatch your
quality of life and your long-term health.” (Moynihan, Heath, &
Henry, 2002).
Marketing effort of Glaxo Smith Klines is well known for
certain diseases. The stated aim in a communication to their
medical writer was “IBS [irritable bowel syndrome] must be
established in the minds of doctors as a significant and discrete
disease state”. Patients also “need to be convinced that IBS is a
common and recognized medical disorder”. The other main
messages for education are about promoting the new “clinically
proven therapy”—Lotronex. What for many people is a mild
functional disorder—requiring little more than reassurance
about its benign natural course—IBS is currently being re-
framed as a serious disease attracting a label and a drug, with
all the associated harms and costs (Moynihan, Heath, & Henry,
2002).
A new form of disease mongering has infiltrated the public
domain, the concept of beauty and health combined to increase
the sale of cosmetics and to propagate cosmetic surgery. A
more detailed discussion is out of scope of the article, but in-
terested readers can seek insight from a very interesting account
of “Cosmetic Gynaecology” that proposes to give aesthetically
right private reproductive parts to women who can pay (Lee,
2011).
Packaging for Profit: Case of “Cocktail Vaccines”
The business emanating from the preventive approach to
diseases needs our attention. The marketing of various vaccines
originating in developed countries have found large-scale mar-
ket in the poorer nations, where need of many of the vaccines
from a public health perspective remains questionable. The
business model here is sensitization of public by the industry
involving lobbying physicians, nutrition experts, health care
workers to symptoms or disease and their new cures.
Indian physicians have argued against the use of certain vac-
cine as recommended by World Health Organization (Puliyel &
Madhavi, 2008). The World Health Organization directive of
using pneumococcal vaccine universally based on data and
local study carried out in Indonesia and Africa has been criti-
cally reviewed in India where there is no local significant bur-
den from this disease in multiple surveillance studies. Indian
population has a natural immunity to such infection and the
local conditions warrant allocating scarce resources to more
important issues at hand. There are nonessential vaccines that
tend to piggyback over the essential vaccines, raising both cost
and profit.
Over the last few decades, due to the decline of the public
sector and the growing disinterest of the private sector, the
number of firms supplying the basic vaccines has declined
drastically. There is attempted marketing of “value-added
cocktail vaccines” at exorbitant prices in the open market. Pri-
vate for-profit pharmaceutical industries are disinterested to
produce the basic vaccines that are cheaper to produce and
bring them less money in return. Nevertheless, “formulations
where they combine number of vaccines” can be sold at higher
prices. The combination of DPT with hepatitis B raises the
price of DPT immunization 17 fold. Moreover, the relative
safety and efficacy of these cocktail combinations are said to be
much lower than their individual components.
Neglecting the Poor Diseases: Avoiding Loss
People of the western world equate tropical disease with the
big three—HIV/AIDS, tuberculosis, and malaria. However,
another worrisome group of diseases known as neglected tropi-
cal diseases (NTDs) has an even more widespread impact to
public health. These neglected tropical diseases occur among
populations who live on less than US $2 per day or below the
World Bank poverty figure of US $1.25 per day. The neglected
diseases, as notified in World Health Organization literature,
Table 4.
Neglected Diseases as per World Health Organization.
1. Buruli ulcer
2. Chagas disease (American trypanosomiasis)
4. Dengue/severe dengue
5. Dracunculiasis (guinea-worm disease)
6. Echinococcosis
7. Fascioliasis
8. Human African trypanosomiasis
9. Leishmaniasis
10. Leprosy
11. Lymphatic filariasis
12. Onchocerciasis
13. Rabies
14. Schistosomiasis
15. Soil transmitted helminthiasis
16. Trachoma
17. Yaws
242

S. HAZARIKA, A. R. DUTTA
are mentioned in Table 4 (quoted from Trouiller, Olliaro, Tor-
reele, Orbinski, Laing, & Ford, 2002). The NTDs represent a
group of chronic parasitic and related bacterial and viral infec-
tions that actually promote poverty. These conditions are of low
virulence and may not often kill, but they negatively affect
health by causing severe anemia, malnutrition, delays in intel-
lectual and cognitive development, and blindness. Some of
these diseases can lead to horrific limb and genital disfigure-
ment and skin deformities and may also increase the risk of
acquiring HIV/AIDS.
Other “neglected” conditions: Podoconiosis, Snakebite,
Strongyloidiasis were for tropical diseases and tuberculosis
(Trouiller , Olliaro , Torreele , Orbinski, Laing, & Ford, 2002).
N. It was found that there is a 13-fold greater chance of a
drug being brought to market for central nervous system disor-
ders or cancer than for a neglected disease. To this effect, the
argument from the industry was that research and development
for newer compounds are costly and it is risky to invest in low-
return neglected diseases suffered by people leaving in poor
economies. The lack of drug research and development for
“non-profitable” infectious diseases will require new strategies
from the public policy experts. Currently, there is palpable
dearth of interest to control the re-emergence of human African
trypanosomiasis, to replace the ineffective and toxic drugs for
Chagas’ disease, to overcome resistance to antileishmanial and
antimalarial drugs, and to develop more effective drugs for
tuberculosis to shorten treatment time, and to address mul-
tidrug-resistant diseases.
The danger of mixing profit motive with the basic right of
health care can rarely cite a better case than this on the perils of
unregulated research oriented profit. Millions leave with dis-
ease in the global south, where infectious diseases are the kill-
ers and modern science is perfectly capable of fighting them, if
profit motive vanishes.
Conclusion
The explicit trend of profiteering over sickness at the behest
of the corporate health and pharmaceutical industries is a huge
challenge to human civilization and its long cherished goals
like universal rights, freedom, and justice. It is now a syndrome
of a systemic crisis—a crisis in which largely unregulated
healthcare system can produce sickness by a technologically
driven culture of diagnosis of diseases. In such a system, the
noble efforts of agencies such as World Health Organization,
United Nations Development Program or UN Millennium Dec-
laration get completely undermined and marginalized. The
profit oriented healthcare care system has so overpowered itself
by subduing the natural and universal benefits of scientific
discovery, and conventionally perceived power of science and
technology to enable human being to confront with odds in
day-to-day life has also been sabotaged by the corporate forces.
Under such a system, healthcare is degraded into a human body
shop, a body shop of engineering and marketing human organs
and human disease. The time is up to confront this body shop,
which can, however, be done only by radically transforming the
healthcare system itself in which health care seekers and not the
health care providers will occupy the center stage. Such a
transformation will, however, require challenging the global
economic and trade regime, which will, of course, be a difficult
challenge but not an impossible one.
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