Which Comes First: Curing the Sick or Making a Profit?

Dr. Relman

Dr. Relman

Dr. Arnold Relman had a healthy attitude toward his own death and put wellbeing above materialism.

Longtime editor of the New England Journal of Medicine Editor and health system critic, Dr. Relman died recently at the age of 91 from melanoma. He recently said, “There’s a certain comfort that comes from understanding that there’s no life without death… I’ve seen lots and lots of deaths in my professional lifetime. It makes me more philosophical… Doctors learn to accept that as part of life. Although we consider death to be our enemy, it’s something that… we deal with all the time, and we know that we are no different. My body is just another body.”

Relman abandoned the study of philosophy to rise to the top of the medical profession as a researcher, administrator, and editor of The New England Journal of Medicine, which became a platform for his early and influential attacks on the profit-driven health care system. Founded in 1812, it is the oldest continuously published medical journal in the world, reaching more than 600,000 readers a week. Relman required authors to disclose any financial arrangements that could affect their judgment in writing about the medical field, including consultancies and stock ownership.

He was also editor of The Journal of Clinical Investigation and wrote hundreds of articles. In an essay in the New England journal on Oct. 23, 1980, Dr. Relman issued the clarion call that would resound through his career, assailing the American health care system as caring more about making money than curing the sick. He called it a “new medical-industrial complex.”

And he taught and did research at Boston University, the University of Pennsylvania, Oxford, and Harvard.

Dr. Relman and his wife, Dr. Marcia Angell, shared a George Polk Award, one of journalism’s highest prizes, for an article in 2002 in The New Republic that documented how drug companies invest far more in advertising and lobbying than in research and development.

His targets were not the old-line drug companies and medical-equipment suppliers, but rather a new generation of health care and medical services—profit-driven hospitals and nursing homes, diagnostic laboratories, home-care services, kidney dialysis centers and other businesses that made up a multibillion-dollar industry. “The private health care industry is primarily interested in selling services that are profitable, but patients are interested only in services that they need,” he wrote.

In 2012, asked how his prediction had turned out, Dr. Relman said medical profiteering had become even worse than he could have imagined.

His prescription was a single taxpayer-supported insurance system. To control costs, he advocated that doctors be paid a salary rather than a fee for each service performed.

The health care system, he said, needs a more aggressive solution to fundamental problems. “Many people think that doctors make their recommendations from a basis of scientific certainty, that the facts are very clear and there’s only one way to diagnose or treat an illness. In reality, that’s not always the case. Many things are a matter of conjecture, tradition, convenience, habit. In this gray area, where the facts are not clear and one has to make certain assumptions, it is unfortunately very easy to do things primarily because they are economically attractive.”

This blog consists mostly of parts of the New York Times obituary by Douglas Martin, June 21, 2014.

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