Former NEJM editor Arnold Relman dies at 91

RelmanSee Storify for updates. 

Arnold Relman, the former New England Journal of Medicine editor, has died. From Bryan Marquard at the Globe: 

Eloquent and forceful on the page or the podium, Dr. Arnold Relman led the New England Journal of Medicine for more than 13 years, raising a sometimes lonely voice to warn about the dangers of for-profit medicine when many in politics and his profession raced to embrace a free market approach.

Dr. Relman also was one of the nation’s foremost writers about the rising cost of health care. Persistent to the end, he received the galleys of his final article just a few days before he died of cancer in his Cambridge home early Tuesday, on his 91st birthday.


When he suffered a catastrophic fall last year, he wrote about it in The New York Review of Books:


Since then, I have made an astonishing recovery, in the course of which I learned how it feels to be a helpless patient close to death. I also learned some things about the US medical care system that I had never fully appreciated, even though this is a subject that I have studied and written about for many years.


What he reported was not flattering to Spaulding Rehab, the hospitals that has won praise for working with so many marathon bombing survivors.

What did this experience teach me about the current state of medical care in the US? Quite a lot, as it turns out. I always knew that the treatment of the critically ill in our best teaching hospitals was excellent. That was certainly confirmed by the life-saving treatment I received in the Massachusetts General emergency room. Physicians there simply refused to let me die (try as hard as I might). But what I hadn’t appreciated was the extent to which, when there is no emergency, new technologies and electronic record-keeping affect how doctors do their work. Attention to the masses of data generated by laboratory and imaging studies has shifted their focus away from the patient. Doctors now spend more time with their computers than at the bedside. That seemed true at both the ICU and Spaulding. Reading the physicians’ notes in the MGHand Spaulding records, I found only a few brief descriptions of how I felt or looked, but there were copious reports of the data from tests and monitoring devices. Conversations with my physicians were infrequent, brief, and hardly ever reported.

What personal care hospitalized patients now get is mostly from nurses. In the MGHICU the nursing care was superb; at Spaulding it was inconsistent. I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled. This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good.

More on that piece from The NYTimes. 


Relman often commented on the influence of money on medicine. In 20o9,  he crashed the inaugural meeting of the Association of Clinical Researchers and Educators (ACRE) “an organization of medical professionals dedicated to the advancement of patient care through productive collaboration with industry and its counterparts.”

So, we asked for his thoughts about the presentations. Here they are:

“I sat through the whole program, which was a sustained diatribe against conflict-of-interest regulations rather than a scholarly, balanced discussion of the issues. There was practically no time for audience questions or comments, but instead an almost unrelenting barrage of ideological and anecdotal criticism of what was said to be a misguided “belief system” that worries excessively over relations between industry and the medical profession. There was an occasional informative and reasonable contribution, but for the most part sarcasm and anger prevailed.
The heavily industry-related audience loved the performance, but the obviously biased, self-serving, and often grossly flawed presentations should have embarrassed the organizers. Although neither Harvard Medical School nor the Brigham & Women’s Hospital sponsored or formally endorsed the meeting, the HMS Dean did give the initial welcoming remarks, and the Hospital offered its facilities for the event. One can only hope that they are now having second thoughts.”
More here:

How the Supreme Court same-sex marriage rulings will impact health care #DOMA #SCOTUS

Profoundly, it seems. The decisions to uphold same-sex marriage are just coming out.  Since lots of people get health insurance through their spouses, the impact will be huge. Here is New England, where same-sex marriage is legal, HR offices for federal agencies should expect a spurt in family coverage.

Kaiser Health News posted a what-if story on DOMA in April:

According to a report published by two think tanks, the Center for American 

Progress and the Williams Institute, which conducts 

Screen Shot 2013-06-26 at 11.19.48 AM

research on gender identity and sexual orientation, an employee who buys health insurance for a domestic partner of the same or opposite sex pays $1,069 more a year in federal taxes, on average, than a worker in a heterosexual marriage would pay for the same coverage.

Nine states and the District of Columbia currently permit same-sex mar

riage, according to the National Conference of State Legislatures.

The Gay and Lesbian Medical Association filed a brief in the DOMA case.

BHN looked at gay health issues during the 2009  gay pride events in Boston.

Does Berwick have a fix for Massachusetts that he didn’t get to try in DC?

berwickIn addition to the rest of the state’s problems, would-be Governor Don Berwick would inherit the post-mandate struggle to contain health care costs. Does he have any solutions for  Massachusetts that he didn’t get a chance to try in DC?

Last summer, the former Medicare chief gave a talk before a film about the failures of U.S.  health care.  Instead of demonizing doctors and drug companies , he said they are just working within the system as it stands.

They’re just doing what makes sense,” he said. “We have to change what makes sense.”

Read full post here. 

For more on Dr. Berwick see:

#Medicare boss Berwick for Massachusetts governor? Changing what makes sense #hcr #mapoli

Sure sounds like it from the Globe story.

Berwick, a Newton pediatrician and longtime Harvard faculty …has been contemplating a run for the past two or three months, meeting with 40 or 50 people, including political veterans and consultants. …“I’m strongly considering it,” said Berwick, whose interest in the office was first reported by State House News Service.  While he would bring deep policy knowledge to a governor’s race, it is unknown whether Berwick can mount a serious candidacy, as a newcomer to politics who has never raised money or glad-handed voters at a strip mall.

More from Politico.

BHN caught up with Dr. Berwick on Martha’s Vineyard this summer, where he introduced a health care documentary. There, he talked about the people who came to see him during his short tenure in Washington:

Instead of demonizing doctors and drug companies, he doesn’t blame any of the players, who are working within the system as it stands.

“They’re just doing what makes sense,” he said. “We have to change what makes sense.”

 For more on Dr. Berwick see:

Hounded ex-Medicare chief Berwick back in Boston

Donald Berwick, who was hounded out of Washington for saying something nice about the UK health system, is back in town and on WBUR today.

Also check out today’s NTYimes op/ed by Joe Nocera:

Dr. Donald Berwick was already in Massachusetts when I spoke to him Sunday afternoon. He was back in the Newton home where he’d lived for 30 years, being pleasantly interrupted during our conversation by his 2-year-old grandson. His last day in Washington as the administrator of the Centers for Medicare and Medicaid Services had been Thursday. Friday was packing day. Saturday was moving day. And, by Sunday, he was already talking about his too-short, 17-month tenure as the nation’s top Medicare official in the past tense. Which, alas, it was.       

Dr. Berwick, I’m here to tell you, was the most qualified person in the country to run Medicare at this critical juncture, and the fact that he is no longer in the job is the country’s loss.

Health policy digest takes on reform loopholes and clueless reporters

The latest edition of the roaming digest of health policy blogs;

Health Wonks – the SuperHero Edition!!!

The deficit battle is on and politicians are in full voice – both in Washington and out on the hustings, where GOP candidates are loudly denouncing health reform as unAmerican and a job killer.  Hipsters and greying hippies are occupying Wall Street and Main Street, while Tea Partiers are claiming they hold the title of most outraged.  The one percent is wondering what the 99 percenters are so upset about, while the 99 percenters are after their well-coiffed scalps.

Into the bloody fray, with nary a fear for life or health, reputation or career, plummet our worthies, those denizens of the blog-o-sphere that specialize in separating the non- from the -sense, the BS from the fertilizer, the ill-formed opinion from the logically-based interpretation!

Join us as we follow their heroic deeds, gasp as you read their trenchant and timely missives, awed by their grasp of the incredibly-esoteric and yet critically important.

Occupy Health Care: Boston protesters say Wall Street makes them sick

While health reform may not be at the top of their agenda, some of the Occupy Boston protesters down at Dewey Square had no problem linking the high cost of medical care to their complaints about Wall Street.  Some support Obama’s reforms; others called for a single payer system. But, nearly everyone interviewed had universal health care on his or her list of demands.

Even MIT professor Noam Chomsky said  the health care system is tainted by what he described as a government dominated by private corporations. Speaking on Saturday night, he told the crowd that the  federal budget deficit could be eliminated if the US had a health care system like other countries in the developed world — presumably single payer.

Medicare itself is not the problem, he said.

“It’s a problem because it goes through the privatized, unregulated system,” he said. “It is totally dysfunctional. You can’t talk about this in Washington because of the power of the financial institutions. ”

More from the rank and file below.