On June 17, 2014, Dr. Arnold Relman, editor of the prestigious New England Journal of Medicine from 1977-1991, passed away. During his tenure as editor, Dr. Relman highlighted health care policy as a major issue for the Journal by publishing commentary and studies about the delivery of health care and writing editorials about how health care is practiced and paid for.
Throughout his career, Dr. Relman was a champion for focusing on patient care rather than the business of medicine. In his writings, he expressed concern about the "commercialization" of medicine, reminding his colleagues that medicine was a calling and not a trade. He wrote thought-provoking articles on the conflict of interest of for-profit hospitals, nursing homes, and diagnostic laboratories that put profits ahead of what he considered the patients' best interests. As early as 1980, he was quoted as saying, "If we are to live comfortably with the new medical-industrial complex we must put our priorities in order: the needs of patients and of society come first ... How best to ensure that the medical-industrial complex serves the interests of patients first and of its stockholders second will have to be the responsibility of the medical profession and an informed public."
Today, new therapeutics for specific diseases such as certain cancers and hepatitis C can cost tens of thousands of dollars each month. Likewise, the costs of certain diagnostic tests are skyrocketing, and hospital and physician expenses are billed on a procedure basis rather than on successful outcome. And to make matters worse, the major expenses in the health care system are for the treatment of chronic diseases, and these continue to escalate out of control. The business of medicine has created a multitude of profitable treatments for chronic disease, but we continue to see these diseases progressing in number and severity. Why? Is it because we find ourselves locked into a financial model for disease prevention and treatment that puts the patient second behind the preservation of the status quo in the medical-industrial complex? I believe that this is part of the answer. We know the answer to the chronic disease epidemic is not to be found in the development of another expensive medicine alone, but rather in harnessing what we know now about the importance of applying personalized lifestyle medicine.
The patients' best interests are found in the understanding of how genetic uniqueness interacts with lifestyle, diet, and environment. Through this understanding we will be able to design and implement programs for individuals with proper support and incentives that will turn back the rising tide of chronic disease. We need to return to the patient-centered care that Dr. Arnold Relman advocated for throughout his professional life rather than continue with the present disease-centered system if we truly want to reduce the burden of disease.
References:
Snyder A. Arnold "Bud" Relman. Lancet. 2014 Jul 12;384(9938):126.
Relman AS. Medical professionalism in a commercialized health care market. JAMA. 2007 Dec 12;298(22):2668-70.
Relman A. The new medical-industrial complex. N Engl J Med. 1980;303:963-70.
Bloom DE, Cafiero ET, Jané-Llopis E, Abrahams-Gessel S, Bloom LR, et al. 2011. The Global Economic Burden of Noncommunicable Diseases. Geneva: World Economic Forum.