He Tried to Put the Soul Back in Medicine

Andrew Siegel MD Blog # 162

Dr. Arnold Relman died of melanoma on his 91st birthday on June 22, 2014. For 23 years he had been the editor of the New England Journal of Medicine. He was a man of strong convictions and an extremely outspoken individual who cared deeply about the “soul” of American medicine, which he thought had been compromised and violated because of economic concerns.

He was an ardent opponent of the profit-driven American health care system that he referred to as the “medical-industrial complex,” a multibillion-dollar business that he criticized for caring more about finances than for the sick. In 2002 he wrote a scathing article in The New Republic exposing Big Pharma for spending more resources on advertising and lobbying than on research and development. He also targeted profit driven hospitals and nursing homes, diagnostic laboratories, home care services, kidney dialysis centers.

He claimed “the private healthcare industry is primarily interested in selling services that are profitable, while patients are interested only in services that they need.” He first expressed his opinions on the economics of healthcare in 1980 and when interviewed in follow-up more than 32 years later in 2012 he observed, “medical profiteering had become even worse than he could ever have imagined.”

His proposed solution was a single-payer affordable insurance system financed by taxes—similar to Medicare—to replace the hundreds of private, high- overhead insurance companies, which he referred to as “parasites.” To control costs, he recommended that doctors be salaried rather than paid on a fee-for-service basis. He viewed Obamacare as a means of increasing health care access, but a very incomplete reform at best.

He stated “Many people think that doctors make their recommendations on the basis of scientific certainty, that the facts are very clear and there is 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 and 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.”

Dr. Relman was responsible for requiring authors to disclose financial conflicts of interest—such as stock ownership or being employed as a consultant to the pharma company or device company that put out the product that was the subject of the article—that could and would affect the conclusions of the study. What he originated has become standard practice among peer-reviewed journals

He graduated at age 19 from Cornell University with a degree in philosophy and received his MD from Columbia at age 22, a brilliant, principled man with ethical ideals and a profound interest in public health and the absolute need for our health care system to be purified of tainted commercial interests.

Much if the information from this blog was obtained from the obituary of Dr. Relman written by Douglas Martin and published in the New York Times on Sunday, June 22, 2014.

Andrew Siegel, M.D.


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One Response to “He Tried to Put the Soul Back in Medicine”

  1. Jay Rosen Says:

    Andy, Thank you for enlightening me about this great man. I happen to have very similar beliefs. Jay

    Sent from my iPad


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