Monday, June 23, 2014

qotd: Arnold “Bud” Relman

The New York Times
June 21, 2014
Dr. Arnold Relman, Outspoken Medical Editor, Dies at 91
By Douglas Martin

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."

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.

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."


Physicians for a National Health Program (PNHP)
The Arnold Relman Memorial Fund

From "Physicians and Politics" by Arnold S. Relman, M.D., in JAMA
Internal Medicine, June 2, 2014:

"A new health care system that provides universal access and is
affordable and efficient will be difficult to achieve. The private
insurers and all the other businesses that profit from the current
commercial system will resist it. Major reform will need wide public
support, which in turn will rely on advocacy by the medical profession.
But I believe that reform will nevertheless be eventually enacted
because it meets a widely shared and growing public desire for more
fairness in an American society pervaded by inequality in access to good
health care and many other social benefits.

"Physicians have a unique power to reshape the medical care system. They
are what makes it work and are best qualified to use and evaluate its
resources. But if they never unite to press for major reform, the future
of health care in the United States will indeed be bleak. We will end up
either with a system controlled by blind market forces or with a system
entangled in complicated and intrusive government regulations. In either
case it would be impossible to practice good patient-centered medicine,
and the quality and effectiveness of our health care system would sink
even lower among the ranks of developed countries. It is up to the
medical profession to see that this does not happen."

Dr. Arnold S. Relman, professor emeritus of medicine and social medicine
at Harvard Medical School, and past editor-in-chief of The New England
Journal of Medicine, died on June 17, 2014. He was 91.

Dr. Relman was one of the most distinguished figures in U.S. medicine,
and he leaves a rich legacy of research and writing on the economic,
ethical, legal and social dimensions of health care.

An important part of this legacy is embodied in his influential book, "A
Second Opinion: A Plan for Universal Coverage Serving Patients Over
Profit," in which he makes an impassioned case for establishing "a
single-payer system sponsored by the federal government" coupled with "a
reorganized medical care system based on independent multispecialty
group practice with salaried physicians."

Among Dr. Relman's many achievements during his tenure as
editor-in-chief at the NEJM, he oversaw the journal's publication of "A
National Health Program for the United States: A Physicians' Proposal,"
by Dr. David U. Himmelstein, Dr. Steffie Woolhandler, and 29 others. At
the time, in 1989, the article's appearance in the NEJM represented a
major breakthrough for the mainstream discussion of single payer in the
medical profession. It also served as a seminal article in the
establishment of Physicians for a National Health Program.

In addition to Dr. Relman's numerous awards and honors from professional
societies, scientific academies, and universities, in November 2013 he
was presented with PNHP's Dr. Quentin D. Young Health Activist Award for
his unswerving advocacy for a more just and equitable health care system
in the United States.

Dr. Relman leaves his wife, Dr. Marcia Angell; two sons, Dr. David
Relman and John Relman; a daughter, Margaret Batten; six granddaughters;
and two stepdaughters, Lara and Eliza Goitein.

Shortly before his death, Dr. Relman asked that in lieu of flowers,
donations in his memory be directed to PNHP.

Physicians for a National Health Program is honoring Dr. Relman's legacy
by establishing The Arnold Relman Memorial Fund, dedicated to expanding
PNHP's special outreach programs to the medical profession, including to
medical residents and fellows, to advance the understanding and
realization of Dr. Relman's vision.

The Arnold Relman Memorial Fund


Comment by Don McCanne

Although some have described Dr. Relman's 1980 New England Journal of
Medicine essay on the medical-industrial complex as controversial, it
would better be described as a release of the medical profession from
the shackles of the old conservative guard of organized medicine.
Although always exercising editorial independence, the NEJM was a
publication of the Massachusetts Medical Society - the state chapter of
organized medicine. For those of us on the West Coast who were somewhat
removed from Boston and Chicago medical politics, Dr. Relman became and
remained a beacon of hope for the future of a health care system that
would be wholly dedicated to the patient rather than to vested interests.

Perhaps the greatest breakthrough was in 1989 when he published in NEJM
"A National Health Program for the United States: A Physicians'
Proposal," by Dr. David U. Himmelstein, Dr. Steffie Woolhandler, and 29
others. That signaled the start of a movement coming from within the
medical profession in support of health care justice for all.

Although Dr. Relman had requested that donations be made to PNHP in lieu
of flowers, the paramount action that we should take is to honor his
legacy by intensifying our efforts to transform our health card system
from a medical-industrial complex into a nirvana of the healing arts.
That does require that we become more thoroughly enmeshed in technical
details such as enacting an Expanded and Improved Medicare for All. But
Bud Relman wouldn't have it any other way.

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