Beware of the medical-industrial complex

Dr. Arnold Relman, Outspoken Medical Editor, Dies at 91

By DOUGLAS MARTINJUNE 21, 2014

Photo
Dr. Arnold S. Relman in 1979 at The New England Journal of Medicine. He led it for 23 years. Credit Associated Press

Dr. Arnold S. Relman, who abandoned the study of philosophy to rise to the top of the medical profession as a researcher, administrator and longtime 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, died at his home in Cambridge, Mass., on Tuesday, his 91st birthday.

His wife, Dr. Marcia Angell, said the cause was melanoma.

Dr. Relman and Dr. Angell filled top editorial posts at the journal for almost a quarter-century, becoming “American medicine’s royal couple,” as the physician and journalist Abigail Zuger wrote in The New York Times in 2012.

The couple 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 extended critique of the medical system was just one facet of a long and accomplished career. Dr. Relman was president of the American Federation for Clinical Research, the American Society of Clinical Investigation and the Association of American Physicians — the only person to hold all three positions. He taught and did research at Boston University, the University of Pennsylvania, Oxford and Harvard, where he was professor emeritus of medicine and social medicine.

Early in his career, he did pioneering research on kidney function.

He was also editor of The Journal of Clinical Investigation, a bible in its field, and he wrote hundreds of articles, for both professional journals and general-interest publications. Days before he died, Dr. Relman received the galleys of his final article, a review of a book on health care spending for The New York Review of Books, to which he was a frequent contributor.

In a provocative essay in the New England journal on Oct. 23, 1980, Dr. Relman, the editor in chief, 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” — a deliberate analogy to President Dwight D. Eisenhower’s warning about a “military-industrial complex.”

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 an editorial, The Times said he had “raised a timely warning.”

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, 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.
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Dr. Relman recognized that his recommendations for repairing the health care system might be politically impossible, but he insisted that it was imperative to keep trying. Though he said he was glad that the health care law signed by President Obama in 2010 enabled more people to get insurance, he saw the legislation as a partial reform at best.

The health care system, he said, was in need of a more aggressive solution to fundamental problems, which he had discussed, somewhat philosophically, in an interview with Technology Review in 1989.

“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,” he told the review. “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.”

Dr. Relman edited The New England Journal of Medicine from 1977 to 2000. Founded in 1812, it is the oldest continuously published medical journal in the world, reaching more than 600,000 readers a week.

When he took the journal’s helm, interest in health news was booming, and newspapers and magazines competed to be first in reporting new developments. One policy he instituted was to ask general-interest publications not to disclose a forthcoming article in advance, a request almost always honored, albeit sometimes grudgingly.

He also began requiring authors to disclose any financial arrangements that could affect their judgment in writing about the medical field, including consultancies and stock ownership.

Dr. Relman and Dr. Angell met when she was a third-year student in one of his classes at Harvard Medical School. They published a paper on kidney disease together in The New England Journal of Medicine, then did not see each other for years.

After he became the journal’s editor, he asked her to come on board as an editor, which she did, abandoning her career as a pathologist. They began living together in 1994 — both were divorced by then — and married in 2009.

They became the ultimate medical power couple, not least because they were gatekeepers for one of the world’s most prestigious medical journals. Their outspoken views further distinguished them.

“Some have dismissed the pair as medical Don Quixotes, comically deluded figures tilting at benign features of the landscape,” Dr. Zuger wrote in The Times. “Others consider them first responders in what has become a battle for the soul of American medicine.”

Arnold Seymour Relman was born on June 17, 1923, in Queens (in an elevator, according to Dr. Angell) and grew up in the Far Rockaway neighborhood. His father was a businessman and avid reader who inspired his son’s love of philosophy. His mother nicknamed him Buddy, and friends called him Bud the rest of his life.
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He skipped grades in school and graduated at 19 from Cornell with a degree in philosophy, but he chose not to pursue the field because it “seemed sort of too arcane,” his wife said. He earned a medical degree from the Columbia University College of Physicians and Surgeons at 22. His first marriage was to Harriet M. Vitkin.

In addition to Dr. Angell, he is survived by his sons, David and John, and a daughter, Margaret R. Batten, all from his first marriage; his stepdaughters, Dr. Lara Goitein and Elizabeth Goitein; six granddaughters; and four stepgrandsons.

Last June, Dr. Relman fell down a flight of stairs and cracked his skull, broke three vertebrae in his neck and broke more bones in his face. When he reached the emergency room, surgeons cut his neck to connect a breathing tube. His heart stopped three times.

“Technically, I died,” he told The Boston Globe.

He went on to write an article about his experience for The New York Review of Books, offering the unusual perspective of both a patient and a doctor.

“It’s both good and bad to be a doctor and to be old and sick,” he told The Globe.

“You learn to make the most of it,” he added. “Schopenhauer, the German philosopher, said life is slow death. Doctors learn to accept that as part of life. Although we consider death to be our enemy, it’s something we know very well, and that we deal with all the time, and we know that we are no different. My body is just another body.”

A version of this article appears in print on June 22, 2014, on page A23 of the New York edition with the headline: Dr. Arnold Relman, 91, Outspoken Medical Editor, Dies. Order Reprints|Today's Paper|Subscribe

Purgatory

Randy was first scheduled in 2010 to go to GF Strong for rehab but instead at the last minute he was sent to live at George Pearson Centre in purgatory. Why was the direction of his treatment changed?

Coerced Sterilization in Virginia

From: Bioedge June 2014

A petty criminal sentenced to become sterile. Commentary from Bioedge:

Perhaps Ms White lacks a sense of history, or she would have sensed the irony of compulsory sterilization in Virginia. In 2002, the 75th anniversary of a notorious Supreme Court decision, Buck v. Bell, Virginia Governor Mark Warner publicly apologized for the state’s past involvement in eugenics. He said, "The eugenics movement was a shameful effort in which state government never should have been involved."

Carrie Buck was a young woman whom the commonwealth of Virginia wanted to sterilise because she came from bad stock. The case went all the way to the US Supreme Court, which ruled, in an 8-1 decision, against Ms Buck. The majority ruling was written in 1927 by the legendary Oliver Wendell Holmes Jr, whose imperishable argument was:

“It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes. Three generations of imbeciles are enough. "

After nearly a century, perhaps the commonwealth of Virginia has come full circle in its attitude toward eugenics. Except that now, two generations seem to be enough.
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Blog2Print

As it is difficult to read and put in context my blog posts, I can print copies of my posts in paper form (soft cover book). This professional service is provided by Blog2Print. The cost is $50.00, so if you want a printout, just send me a cheque or money order. My Blog2Print book is easier and thus more interesting to read and refer to. The cost of the Blog2Print book is its cost and I will send you a photocopy of the Blog2Print invoice. .

13 June 2014 Two Month Anniversary

Today is the two month anniversary of Randy's death. I am in terrible grief. It isn't because he died but rather the way he died. Vancouver Coastal Health treated us like we were less than human.

Only the sociopaths knew what was good for Randy and I. No one showed any compassion for his death; no one even went to his memorial service at George Pearson Centre. His home. I wasn't even invited as if I was a what I do not know.

All I see from the nursing staff from GPC and also VGH is indifference; not a kind word; or even a small tear. Nothing.

If I didn't have a BC supreme court order to be with Randy should he be in intensive care, VCH would have got away with its threat of me never being with him at his bedside when he died. Thank you Linda Rose.

I still do not know what he died from. I asked for an autopsy but it never came. Why did they keep fighting: Roberts and Dunne about where Randy should go. Roberts did not want him at VGH as his care was too costly and neither did Dunne want him at GPC as GPC did not have personnel to properly look after Randy. Since he would never get well I suspect they put a futile order on him and let him die. VCH does not have a policy re futile, a doctor just decides and that is it.

Forget about a doctor talking to a family, he will only talk to a family if he knows the family will agree with him. Randy was in no pain, he just wanted to live.

And to make it worse most of this had nothing to do with Randy but everything to do with me and my behavior as defined by a star chamber The star chamber was first defined to me as the team of doctors and techs who looked after Randy however when I asked the team one by one over the years if they were aware of my banning all of them negated except for Tanu, Marion, and Bob Chapman. I believed that no majority would have denied me access. And the majority of the team didn't as they did not know what was going on. And of course the residents and visitors knew nothing of the banning as well. VCH are so used to banning visitors and they never coming back and there is no effective way of complaining as the complainer is always at fault. The cause for the banning is never made public. The person just goes away. I remember asking what did I do wrong and I was told you knew what you did. No, I do not know what I did to cause Randy such psychological pain.

GPC has so much control over its residents that GPC reads every single piece of mail as well as every single email that goes in and out of GPC. As for cameras they are all over the place except viewing the resident in his bed so that any wrongdoing done by the nurses are not recorded. And nurses report everything you say to management. And VGH has "baby monitors" so they can hear everything that is going on and they might even be recording everything.

I am so sorry Randy. I should have fought harder for you. You trusted me and I failed you.

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Grieving and Euthanasia

Monday, June 9, 2014 Euthanasia threatens the lives of the grieving. My son Frank died in a car accident in 1997. He was 19. He was my oldest child, my only son (I have 3 daughters). In the first year after his death, I wanted to die. I wanted the agony and pain I was feeling to end. Death seemed to be the only way. Yet, I did not REALLY want to die. I wanted the PAIN to die. The second year after his death was even worse. It was not until the third year that I started to heal. I became involved in Bereaved Families of Ontario in Kingston Ontario, and I soon realized that almost all mother's feel the same way. I met a mom - both of her daughters were killed on the same day in a car accident (they were 19 and 16) and she had no other children. We hear stories similar to this often on the news. This pain of the bereaved parent is felt physically, emotionally and spiritually. Some parents build shrines in their homes for their lost child, and never really heal. Some are mad at God. I felt torn apart, physically. I hurt all over. It was as if my body was rebelling against Frank's death. Emotionally I was a mess. It doesn't matter if you have other children when one of them dies. Sometimes, the other children suffer more because at a time when they need you the most, you are least available to them. I can see the problem of euthanasia extending its deathly grip on the bereaved. What about the widows and widowers who can't bear to live without their spouse? We need our governments to put more money into programs to help the bereaved before this is another group targeted by the euthanasia movement. Bill 52 which was just passed in Quebec frightens me. Sincerely, Caroline Yates Kingston, Ontario Posted by Alex Schadenberg at 4:44 PM

A neighbour

I just spoke to a man who told me a story about his mother-in-law who was diagnosed with an enlarged heart and was dying. It was in the days when family members could decide would is best for their members and he quickly took her out of the hospital to her home where she continued to live for one year more. Another friend of mine took her grandmother out of the hospital who also had a serious heart condition and she lived three more years. So how many stories like this are out there.