Sunday, June 22, 2014

Arnold Relman, MD, Outspoken Medical Editor, Dies at 91

His nature is too noble for the world…His heart’s his mouth; What is breast forges, that his tongue must vent.

Shakespeare (1564-1616), Coriolanus

In its obituary today, the New York Times characterized Dr. Arnold as “outspoken.”

Outspoken he was. When I interviewed him 26 years ago, he struck me as an academic medicine professor turned preacher and evangelist for progressive causes. The interview appeared in a 1988 issue of Minnesota Medicine and was entitled “Arnold Relman’s Thoughts on The Journal and Medicine’s Future.” The Journal, of course, was The New England Journal of Medicine, of which he was editor from 1977 to 2000.

His driving cause was eliminating for-profit medicine:

Single-payer medicine. In the words of The Times, “His prescription was a single taxpayer-supported insurance system, like Medicare, to replace hundreds of private, high-overhead insurance companies, which he called ‘parasites’ .To control costs, he advocated that doctors be paid a salary rather than a fee for each service performed.”

His targets of contempt were:

Profit-driven insurance companies, pharmaceutical companies, device manufacturers, hospitals and nursing homes, diagnostic laboratories, home-care services, kidney dialysis centers, and any health care business that made a profit out of healthcare.

One should simply not make money of medicine. It was too noble a profession and too altruistic an undertaking to pursue for the almighty dollar. Profiteering in any form was a no-no. The “medical industrial complex,” as he called it in a 1981 New England Journal of Medicine, was rotten at its core.

As he put it, “The private health care industry is primarily interested in selling services that are profitable, but patients are interested in services that they need.”

Distracters once called he and his wife, Dr. Marcia Angell, a pathologist and later an editor for the New England Journal of Medicine, , “Medical Don Quixotes, completely deluded figures of the landscape,” but admirers looked upon them as “first responders in the battle for the soul of American medicine.”

The couple shared a George Polk Award for 2002 New Republic article documenting how pharmaceutical companies spent more money on advertising and lobbying than research.

In my interview with him, Relman concluded:

“Free market principles simply do not apply to medical care. The practice of medicine is based on the Samaritan tradition. My concern is that when you try to make what is basically a social service and a professional relationship between a doctor and a patient into a business, you have a clash of two incompatible sets of values. In my opinion, that is one of the main problems the American healthcare system is facing today. We can’t decide. We don’t have a clear vision of what we want our health care system to be. Do we want it to be a business, or do we want it be a social service.”

Relman thought any attempt to covert medicine into a market economy was a “complete failure.” In 2012, he said he regarded ObamaCare as partial reform at best, and he said medical profiteering was worse than he originally imagined. A more aggressive solution was needed, and that was single-payer, a common view when seen through the Boston academic-prism.

Relman was a man of strong opinions. He knew where he stood, and where he stood depended on where he sat, at the helm of America’s and perhaps the world’s most prestigious academic medical journal

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