The most controversial man in healthcare? Why Arnold Relman is sorely missed

It's baffling to me how some vibrant, alive people — ones who dominated their era — can fade away from our collective consciousness in a relatively short period of time.

At a dinner with some healthcare C-suite executives in June, I happened to mention that Arnold Relman had just died at age 91. I got a lot of blank stares and someone asked, "Who's Arnold Relman?"

I gave a simple answer.

For 14 years — 1977 to 1991 — Arnold Relman, MD, was editor of The New England Journal of Medicine, arguably the most prestigious medical journal in the world, reaching close to 600,000 readers a week, and certainly the oldest one, founded in 1812. But there was a great deal more to his life than that. Arnold Relman was the most controversial journalists of his day. He always had something interesting to say, and I remember turning to his editorials with great interest. I didn't always agree, but I found great value in what he had to say.

In his day, Dr. Relman functioned as the conscience of our healthcare system. In a provocative editorial in NEJM on Oct. 23, 1980, he accused the system of caring more about making money than aiding the sick. He called it the "new medical-industrial complex," an analogy to President Dwight D. Eisenhower's warning about a "military-industrial complex."

Just as Eisenhower's warning held great weight because it came from the foremost military man of his era, Dr. Relman's warning had impact because it came from one of the most prominent physicians of his time.

His illustrious career had an unusual start. He graduated at 19 from Cornell University with a degree in philosophy, but he quickly abandoned it as "too arcane." By age 22, he had earned a medical degree from the Columbia University College of Physicians and Surgeons in New York City.

The young Dr. Relman produced pioneering research in kidney function early in his career, according to a highly readable obituary of him by Douglas Martin in Dr. Relman wrote hundreds of articles in professional journals and general-interest publications and became editor of The Journal of Clinical Investigation, the bible of its field. He also taught and did research at Boston University, The University of Pennsylvania, Oxford and Harvard, where he was professor emeritus of medicine and social medicine. He was the only person ever to hold all three presidencies of the American Federation of Clinical Research, the American Society of Clinical Investigation and the Association of American Physicians.

It was from this vaunted position that he carried out his war against the "medical-industrial complex." Martin said Dr. Relman didn't chiefly target the old-line pharmaceutical companies and medical equipment manufacturers. Rather, he focused on profit-driven health services that were becoming a multibillion-dollar industry, including hospitals, nursing homes, diagnostic laboratories, home care services and kidney dialysis centers.

"The private health care industry is primarily interested in selling services that are profitable," he wrote in the 1980 editorial. He thought doctors should be paid a salary rather than a fee for service to insulate them from the influence of money. Martin quoted Dr. Relman saying in 1989 that doctors often draw conclusions based on "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."


Long after retiring from the NEJM in 1991, Dr. Relman was still going strong. In 2002, he and his wife, Marcia Angell, MD, shared the Polk award, one of journalism's highest prizes, for an article in The New Republic that documented how drug companies invest far more in advertising and lobbying than in research and development.

Asked in 2012 if for-profit healthcare was still a threat, Dr. Relman responded that medical profiteering had become even worse than he had imagined. Although he liked some aspects of the Patient Protection and Affordable Care Act, he saw it as partial reform at best, and he continued to advocate for a single-payer system that would remove health insurers and their administrative costs. It was the kind of revolutionary change that might seem impossible, maybe even unworkable, but he insisted that we had to find a better solution.

His health took a turn for the worse in the summer of 2013, when he fell down a flight of stairs and broke three vertebrae in his neck and more bones in his face. Surgeons in the emergency room cut into his neck and inserted a breathing tube. His heart stopped three times. "Technically I died," he told The Boston Globe afterwards.

"It's both good and bad to be a doctor and old and sick," he also told the Globe. Hearkening back to his philosophy studies, he quoted Schopenhauer as saying life is a "slow death." He added: "Doctors learn to accept that as part of life. Although we consider death to be our enemy, it is something we know very well, and we deal with it all the time, and we know that we are no different. My body is just another body."

But for those who never knew of Dr. Relman, I'm here to tell you that he was not "just another body." His warnings were not always heeded, but he did make a difference. Since his death, no one has really taken up his mantle, playing the role of prestigious doctor who is everybody's conscience. For that, he is sorely missed.



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