Arnold 5 Relman Former editor in chief of the New England Journal of Medicine

摘要

It often felt like a scolding-even a badgering. Receiving that piercing look from under those formidable bushy eyebrows might have been sufficient, but when Bud Relman was trying to convince you to agree with his opinion on an issue, he told you not only once, but again. And again. And again. And again. Behind this emphatic tactic was a fervor for the values of a profession that he perceived as threatened; a belief rooted in his conviction that commercialism was corrupting the practice of medicine, that the delivery of healthcare had evolved in the wrong direction, and that the integrity of medical science was being compromised. His views were the result of his rigorous and independent assessment of the health system and its environment. He studied it as meticulously as he had studied the kidney's excretion of acid; his economic analyses gained the respect even of the field's experts. He had an eye for spotting trends. Within a few years of becoming editor in chief of the New England Journal of Medicine (NEJM) in 1977, he used that platform to describe what he termed the "new medical-industrial complex," by which he meant a vast intrusion into the health system of investor owned businesses. He warned that profit motives would increase the cost of care. He was one of the first to raise concerns about financial conflicts of interest adversely affecting patient care. He pressed hard for a single payer financing system with no private health insurers, joined to a non-profit delivery system consisting of independent multi-specialty groups of salaried physicians, working within a global budget.