FOR DECADES Russian leaders sacrificed health care to the financial and human resource needs of military and space efforts. Centralized and government controlled in every respect, Soviet health care became disjointed, inequitable, and inadequate.1 Presumably egalitarian, the health care system was in fact strictly hierarchical. Bribery to obtain better quality care was common. Physicians had access only to Soviet medical literature. The government concealed information about scientific and clinical advances produced outside of the Soviet Union from most physicians and the general public. Limited information was available, but only in restricted areas of selected central libraries in Moscow and Leningrad (now St Petersburg). Concurrent environmental pollution, alcoholism,2 tobacco addiction, and poor nutrition led to public health crises of major proportions.3
For editorial comment see p 1622.
Soviet leaders withheld internationally accepted standards of medical ethics, human rights, and patient protection. Thus, Soviet medical ethics did not protect