Saturday, January 16, 2010

Medical Academic Reform - The Perspective of The Medical Academic Political Complex

As Displayed in the New England Journal of Medicine

January 16 - As I write, two big events are taking place.

• Democrats are desperately trying to put together the final version of their health care bill by reconciling the House and Senate versions of the reform bill so President Obama can sign it before delivering his State of the Union Address on late January or early February as a triumph of unprecedented historic significance.

• Next Tuesday, Massachusetts will hold a special election to replace Senator Edward Kennedy’s Senate Seat. To everyone’s astonishment, a Republican, Scott Brown, may beat the Democrat, Martha Coakley. Polls indicate the election is close enough that Presidents Obama and Clinton are in Massachusetts to save the Democrats’ health care bacon. The main issue is the health reform bill. If Brown wins, he may cast a decisive 41st vote against the bill, thereby scuttling it.

A Muddled Muddy Picture

To muddle and muddy the picture even further, a scandal is brewing because of a conflict of interest on the part of Jonathan Gruber, PhD, a MIT professor of economics. Gruber writes often in The New England Journal of Medicine. His latest article on Decmeber 24 was "Getting the Facts Straight on Health Reform, " which supposed corrected critics' misrepresentations of Obamacare. Last June 12, Gruber wrote a piece in The New York Times favoring increased taxation for universal health insurance. He failed to reveal he had received a $392,000 Health and Human Services (HHS) grant. Times felt obligated to apologized, “Had the editors been aware of Professor Gruber’s government ties, the Op-Ed page would have insisted on disclosure or would not have published the article. Also Gruber is a Board member of the Massachusetts Health Connector . The Connector oversees the Bay State’s universal health plan, which many say is the model for

Gruber is said to be President Obama’s health care economist. Republicans claim Gruber is Obama’s health care propagandist, lacks objectivity, and should not be writing articles in The New York Times and New England Journal of Medicine. Gruber is a frequent contributor to the New England Journal’s “ Perspective” Section, now over a year old. In 2009, the section, which leads off each issue of the Journal, contained 197 articles by 275 authors, 81% of whom bearing advanced degrees (MDs 43%, PhDs, 23%. Masters 12%, JDs 5%, 8% others with assorted post-bachelor degrees ), and most of whom hold forth in Boston or New England 40%, Washington, D.C, 18%, California 13%, or the New York –Pennsylvania corridor 10%).

The Perspective of Perspective Authors

What can one say about the perspective of those who inhabit the Medical Academic Political Complex? Overwhelming they are either academics, policy wonks, or government officials. They tend to be bitter enemies of the
Medical Industrial Complex,” a term coined by Arnold Relman, former editor of the New England Journal, who espouses universal coverage and salaried physicians working in nonprofit organizations.

The authors are political liberal, overwhelmingly favor Obamacare, view market forces with deep skepticism , distrust profit-making innovative organizations, and believe the health system can be reformed from the top-down by a well-intended, highly moral government. They dismiss possible unintended consequences of sweeping reform.

Contents of Perspective Section

Their papers concern information technologies 3%, research on various subjects, such as comparative effectiveness research 14%, the FDA 5%, physician practice issues 6%, global health issues 6%, health care legal problems 8%, epidemics 6%, health safety 3%, and health reform 54%.

The perspective throughout is that centralized government has do something about health reform. Not until November 18, 2009, does an article appear by an unabashed Republican, Senator Chuck Grassley of Iowa “Health Care Reform – A Republican View.”

The New England Journal’s “Perspective Section” shows a consistent pro-Obama care bias. One redeeming feature of the series of articles is 24 submissions by John Iglehart, former editor of Health Affairs and national correspondent of the Journal. His pieces show balance and objectivity and chronicle in detail the struggle of Democrats to make “history” by passing reform. Iglehart has written the history of reform, as seen from his Washington, D.C. perch. Taken together his series will be a classic book on health reform.

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