Putting privately owned Russian pharmacies and pharmaceutical factories under state control in 1918/1919 did not improve the output and the distribution of soaps, disinfectants, hormones, vitamins, and medicines. Newly available archival records show that managers appointed by the Soviet government to run sequestered factories employed business methods common to market economies to make the Soviet pharmaceutical sector profitable and productive. However, an inefficient macroeconomy and interference in day-to-day policy-making in the core industry by exogenous officials (frequent reorganization, limits on imports, and excessive exports) hindered production, this plus inefficient distribution shorted consumers. Inadequate amounts of pharmaceuticals undoubtedly contributed to high mortality during the civil war (1917-1921), collectivization and industrialization (1927-1938), and World War II (1939-1945).