Relman, Arnold S. 1923–

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Relman, Arnold S. 1923–

PERSONAL:

Born 1923, in New York, NY. Education: Cornell University, B.A. (with distinction), 1943; Columbia University Medical School, M.D., 1946.

ADDRESSES:

Home—Cambridge, MA. Office—Channing Laboratory, 181 Longwood Ave., 5th Fl., Boston, MA 02115. E-mail—[email protected].

CAREER:

Boston University, School of Medicine, Boston, MA, National Research Council Fellow, faculty member, 1951-68; Journal of Clinical Investigation, editor, 1962-67; Boston City Hospital, Boston, Conrad Wesselhoeft Professor of Medicine and Director of the V and VI Medical Services, 1967-68; University of Pennsylvania, School of Medicine, Philadelphia, Frank Wister Thomas Professor of Medicine and chair of department of medicine, 1968-77; New England Journal of Medicine, editor, 1977, editor-in-chief emeritus, 1991; Harvard Medical School, Boston, professor of medicine, 1977, professor of medicine emeritus, 1993; Brigham and Women's Hospital, Boston, senior physician, 1977—. Columbia University, trustee emeritus and member of Committee on the Health Sciences.

MEMBER:

American Academy of Arts and Sciences (fellow), Institute of Medicine of the National Academy of Sciences, American Federation for Clinical Research, American Society of Clinical Investigation, Association of American Physicians, American College of Physicians (Master), Royal College of Physicians (fellow; London), Phi Beta Kappa (Orator; member of the Senate, 1991).

AWARDS, HONORS:

Macy Foundation Faculty Scholar, Oxford University, and Visiting Scientist in Biochemistry, Merton College, Oxford, 1975-76; Alumni Gold Medal of the College of Physicians and Surgeons of Columbia University, 1981; John Phillips Medal of the American College of Physicians, 1985; Distinguished Service Award of the American College of Cardiology, 1987; Harvard University Commencement, 1990; McGovern Award of the Cosmos Club Foundation of Washington, DC, 1991; Peters Award of the American Society of Nephrology, 1992; Kober Medal of the American Association of Physicians, 1993; invited to serve with the Health Professionals Review Group by the White House, 1993; appointed to the Board of Registration in Medicine of the Commonwealth of Massachusetts by Governor Weld, 1995. Honorary degrees from the University of Pennsylvania, the Medical College of Wisconsin, Brown University, Union University, the State University of New York, the Medical College of Ohio, Temple University, and the Mt. Sinai Medical School of the City University of New York.

WRITINGS:

A Second Opinion: Rescuing America's Healthcare: A Plan for Universal Coverage Serving Patients over Profit, Public Affairs (New York, NY), 2007.

SIDELIGHTS:

Arnold S. Relman, editor-in-chief emeritus of the New England Journal of Medicine, prescribes a radical cure for the country's medical care crisis in A Second Opinion: Rescuing America's Healthcare: A Plan for Universal Coverage Serving Patients over Profit. As Relman writes in an earlier article on the same topic, "The Health of Nations," posted on the Physicians for a National Health Program Web site, the health- care system in the United states is "dysfunctional and extravagantly expensive." American health policies, he argues, "have failed to meet national needs because they have been heavily influenced by the delusion that medical care is essentially a business." This approach, in his view, is "fundamentally flawed." The present system, he writes, "lacks the structure and incentives to improve the quality of care. A not-for-profit system of salaried physicians, who work together in groups that have no financial incentive to do more or less than is medically appropriate, who compete with other medical groups only on the basis of quality and their attractiveness to patients, and whose results are publicly accountable, could be expected to deliver the kind of health care we need." Recognizing that the implementation of such changes would be controversial, Relman nevertheless argues that change must come because the present system is ineffective, inequitable, and unsustainable.

This argument is expanded and thoroughly developed in A Second Opinion. The book attracted much attention from the business world as well as the medical establishment. Relman states his support for a single-payer insurance system, financed through a progressive health-care tax, and a restructuring of the healthcare delivery system to make all hospitals not-for-profit institutions, in addition to making doctors' practices not-for-profit. In this system, physicians would be salaried employees of group practices, rather than maintaining their practices as private businesses.

In an interview with Sandra Hackman and Robert Howard in the Technology Review, Relman explained that the present system has negative effects that are not always readily apparent. "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 said. "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." As Relman observed to Boston Business Journal contributor Michael S. Kirkpatrick, "There has to be some collective financial responsibility" to ensure good quality health care for everyone. "You can't put it all on business, it won't work. It's not fair. Business can't afford it. It's not a sensible thing to do. And I don't think you should put it all on government either. I think that we have to have some sort of pooling of resources. Everybody's got to shoulder some of the burden. That's why the universal health-care bill was passed in this state [of Massachusetts]." Added Relman, "I believe in the free enterprise system. I certainly would not want to see the American health-care system socialized, and I'm also an optimist and I believe in the long run that the common sense and decency of the public will make itself felt. But I'm afraid. What I worry about is that it will happen after we make every mistake that it's possible to make in the book. And we seem to be following that route."

A writer for Publishers Weekly hailed A Second Opinion as a strong argument constructed with "clear, eloquent prose." Ray Olson, writing in Booklist, concluded: "Everyone interested in its issues must read Relman's argument."

BIOGRAPHICAL AND CRITICAL SOURCES:

BOOKS

Relman, Arnold S., A Second Opinion: Rescuing America's Healthcare: A Plan for Universal Coverage Serving Patients over Profit, Public Affairs (New York, NY), 2007.

PERIODICALS

Across the Board, October 1, 1989, Sandra Hackman and Robert Howard, "A Doctor's Advice on Cost Containment," p. 38.

American Medical News, April 13, 1984, "At Senate Subcommittee Hearing: Better Technology Assessment Urged," p. 2; September 14, 1984, Tee L. Guidotti, "Limiting MD Investment in Health Field Ill-Advised," p. 31; August 15, 1986, Harris Meyer, "Journals Reject Attorney's Unusual ‘Warning’ Ad," p. 2; March 11, 1991, Beverly Merz, "Turning a New Page at NEJM," p. 7.

Archives of Internal Medicine, October 11, 1999, Andrew Weil, "Is Integrative Medicine the Medicine of the Future?," p. 2122.

Booklist, May 1, 2007, Ray Olson, review of A Second Opinion: Rescuing America's Healthcare, p. 57.

Boston Business Journal, September 3, 1990, Michael S. Kirkpatrick, "Arnold Relman: A Keeper of the Profession," p. 12.

Boston Magazine, March 1, 1981, "Oracle: When the Journal Speaks, the World Listens," p. 125; April 1, 1985, Gino Guercio, "Choosing a Doctor," p. 152; March 1, 1991, Margaret Pantridge, "Robin Hood and the Docs," p. 64.

Current, November 1, 1989, Sandra Hackman and Robert Howard, "Health Care; Confronting the Crisis," p. 10.

Esquire, November 1, 1980, Joseph P. Kahn, "My Magazine, the Doctor," p. 56.

Forbes, September 26, 1983, Geoffrey Smith, "Roll the DRGs!," p. 36.

Fortune, March 26, 1990, Alicia Hills Moore, "We Are Solving the Problem of Cancer," p. 92.

Future Survey, November, 2007, review of A Second Opinion, p. 20.

Hospitals: Journal of American Hospital Association, November 1, 1982, Ann Forer, "Views of Bromberg, Relman Clash: Profit Motive in Health Care Debated," p. 22; May 1, 1985, Ben Jacques, "For-profit, Not-for-profit Debate Lives On," p. 25.

Humane Medicine, October 1, 1991, "Arnold Relman and His ‘Wonderful Job,’" p. 251.

JAMA: The Journal of the American Medical Association, September 19, 2007, Leonardo Trasande, review of A Second Opinion, p. 1338.

Journal of Health Politics, Policy and Law, February 1, 2003, Eliot Freidson, "Comments on JHPPL Review Symposium," p. 168.

Library Journal, September 1, 1985, Rita Shafer, "New Ventures, New Roles, New York," p. 140; May 1, 2007, Ross Mullner, review of A Second Opinion, p. 97; February 1, 2008, Barbara Bibel, "Best Consumer Health Books of 2007," p. 32.

Los Angeles Times, January 30, 1991, "New England Medical Journal Names New Editor in Chief," p. 19.

Medical World News, June 13, 1988, Patricia Thomas, "Press Lets Candidates off the Hook on AIDS Questions," p. 56; January 23, 1989, Fran Pollner, "Self-Referrals Take More Hits at PPRC Meeting," p. 33; February 1, 1991, Don L. Gibbons, "Thanks, Dr. Relman: That's Our Job," p. 2; May 1, 1991, Emily Friedman, "Journal Editors Wield Word Power: As Journal Editors Take on Higher Profiles Than Their Predecessors, Critics Accuse Them of Courting the Press, Wielding Undue Influence, and Ignoring Primary Care," p. 16.

Medicine & Health, February 21, 1994, "Adapt or Face the Consequences, Relman Tells Teaching Hospitals," p. 2.

Modern Healthcare, April 26, 1985, Mark F. Baldwin, "Critic Contends For-Profit Hospitals Will Cut Back Unprofitable Services," p. 24.

Nature, July 19, 1990, Robin Eisner, "Editorial Position Vacant," p. 208.

New England Journal of Medicine, July 4, 1991, Jerome P. Kassirer, "The Relman Years at the Journal," p. 58; June 28, 2007, Thomas Bodenheimer, "A Second Opinion: Rescuing America's Health Care," p. 2756.

New Republic, August 30, 1982, Ezekiel Emanuel, "The Kidney Experiment: Miracle Cure at Crippling Costs," p. 12.

New York Times, January 30, 1991, "Medical Journal Picks a New Editor in Chief," p. 20; February 5, 1991, Lawrence K. Altman, "Editor of Journal Envisions New Directions and Lighter Tone," p. 3.

Omni, May 1, 1990, Doug Stewart, "Arnold S. Relman," p. 78.

Prevention, October 1, 1983, Kerry Pechter, "Why Are Doctors So Rich?," p. 64.

Publishers Weekly, March 26, 2007, review of A Second Opinion, p. 79.

Science, November 7, 1980, Constance Holden, "Doctors Must Put Patients First, Says Editor," p. 612; February 6, 1981, Nicholas Wade, "Medical Journal Draws Lancet on Rival: JAMA Calls NEJM Elitist; NEJM Says JAMA Is Misguided: Gag Rule Is Bone of Contention," p. 561; September 5, 1986, Barbara J. Culliton, "Medicine as Business: Are Doctors Entrepreneurs?," p. 1032; August 10, 1990, David P. Hamilton, "Relman Hands Over the Reins at NEJM," p. 622.

Scientific American, February 1, 1985, "Healthy Profits?," p. 68.

Technology Review, July 1, 1989, Sandra Hackman and Robert Howard, "Confronting the Crisis in Health Care; an Interview with Arnold Relman," p. 30.

Time, March 3, 1980, "The Ingelfinger Rule," p. 74; March 8, 1982, "Another Sort of Smoke," p. 73.

Wall Street Journal, January 30, 1991, "Kassirer Appointed Editor at New England Journal of Medicine," p. 2.

Yankee, February 1, 1986, Tim Clark, "Confessions of a Worried Doctor," p. 84.