I entered Central Vermont Medical Center last February with mixed emotions. The promise of a COVID vaccine was uplifting. It felt like I was being given a key to a door marked, “Enter with care: new normal straight ahead.” Or so I thought. Being in the 75-and-older club made me eligible for a “gold club”-like status as I joined other elderly folks in the first group to receive the vaccine. I could not help but notice that my compatriots were not exactly the same vigorous folks I remember from the Woodstock days. In fact, the super senior club maintained a rather silent vigil as individuals shuffled along to designated cubicles. After months, weeks, and days of dread, feeling vulnerable, nearly a year of being socially isolated from family and living like a captive sentenced to an uncertain future, the shot offered hope. The nurse injected the vaccine. I felt a deep wave of relief and immediately inquired about the second dose. The nurse gave me the information and added these fateful words, “You can thank Pfizer.” I felt gratitude that several pharmaceutical companies had created an antidote for the dreaded COVID-19 virus. Because of my long history of interaction with this industry, I have confidence that companies such as Pfizer, AstraZeneca, and Johnson & Johnson will take full credit for saving me and the rest of the world. But there is more to the story.For decades, I have been a public critic of the pharmaceutical industry. They are, in my opinion, the robber barons of the 21st century, with policies and practices that have enriched their coffers at the expense of consumers who need and rely on their products. Their vast resources buys them overwhelming political and economic power, which means no one except the industry can set prices for their products, a reality that negatively impacts the lives of every American, now and into the future. Big Pharma has enormous influence and sway in Congress, state legislative bodies, and within the medical industrial complex. Doctors and medical institutions have also been victimized by the industry’s iron grip, but all too often they have become co-conspirators in a corrupt system. Despite cries for reform and regulation, Congress has done little. One feeble response has been a requirement that the industry list possible side effects of the many new drugs that have flooded the marketplace. In recent decades, the companies have assumed a strategy of marketing medications through advertising. One cannot watch an evening TV show without hearing about new pharmaceutical products, including a litany of possible side effects that include fainting spells, dizziness, irregular heartbeat, erections lasting days, not to mention bouts of vomiting or diarrhea. Over the years, I became aware of the industry’s success marketing medications that focus on behavioral health conditions. Using various marketing techniques, including gifts and payments to every sector of the medical community, psychotropic medications became the first line of treatment throughout the country, and it resulted in an excessive level of prescriptions. The pharmaceutical industry encouraged the further expansion of the marketplace by promoting “off-labeling” of products, which encouraged the use of medications beyond their approved uses by the Food and Drug Administration. Excessive levels of prescribing followed, as did profiteering. As a result, in Vermont, reliance on psychotropic medications skyrocketed. Vulnerable populations, ranging from children and adolescents in the state’s Medicaid program to Vermont elders in nursing homes, suffered from over prescribing. This approach even infiltrated Vermont’s correctional system, where inmates were inundated with questionable prescription practices. In one of the very few public censures, at least until the more recent Purdue Pharma scandal, in 2009, the United States Department of Justice announced that Pfizer had been fined $2.3 billion for the illegal promotion of many of their pharmaceutical products. The findings included the improper use of off-labeling products and kickbacks paid to health care providers. The year 2009 was a big year for beginning to address the issue in Vermont. I was one of the instigators in a proposed major bill intended to institute the strictest rules in the nation regarding marketing activities by the pharmaceutical and medical device industries. The legislation called for a ban on all gifts from the industry to the state’s medical community along with a required public disclosure of any expenditures. There was a pitched battle all winter in the Statehouse with pharma devoting time, resources, and lobbyists to defeat the measure. However, our citizen legislature was particularly moved to support the bill when it was revealed that in 2008, Vermont doctors received $3 million in gifts from pharmaceutical companies although there was no public identification of recipients. The bill passed and was signed into law by Gov. Jim Douglas in June, 2009. Besides statewide media coverage, The New York Times called Vermont’s bill “the most stringent state effort to regulate marketing and to change the relationship between pharmaceutical companies and doctors.” On a cloudy March day last year, I dutifully returned to the Medical Center for my second Pfizer shot, feeling that I was being released from bondage. Little did I suspect at the time that I would have to return for a booster shot amid growing uncertainty about the nature and scope of the pandemic. Thanking Pfizer and other companies for finding a remedy to the COVID virus is appropriate, but so too is the realization that until we get control over the pharmaceutical industry, access to affordable healthcare is impossible. Ken Libertoff lives on Sparrow Farm Road in East Montpelier. He was a mental health advocate for three decades at the Mental Health Association. Since retiring in 2010, he is writing memoirs and short stories.