It was a pleasure to see Arnold Relman and Marcia Angell receive such well-deserved visibility in yesterday’s New York Times for their campaigns against the “commercial exploitation of medicine.” Drs. Relman and Angell are both former editors of The New England Journal of Medicine, together and separately, from 1977 to 2000. They are also husband and wife since 2009. He’s 88 and retired, and she’s 72 and still teaches at Harvard Medical School.
Relman and Angell built the NEJM into a formidable editorial platform during their tenures as editors. Much of this came from the quality of the research that they published. But it also derived from their willingness to challenge Big Pharma’s insidious attempt to corrupt the independence of doctors, medical journals, medical education and patients. Here were two highly esteemed physician-editors using the sheer credibility of research and their journal’s reputation to face down the multi-billion pharmaceutical industry, which has unleashed a veritable hydra of wily, unethical schemes to boost profits.
Among them: undisclosed industry payments to researchers to produce studies that make a new drug look good; undisclosed industry payments to leading physicians to teach courses that have the effect of promoting certain drugs and medical devices; undisclosed industry junkets and gifts to physicians to try to encourage more prescriptions of certain medications. And so on.
Under Relman, starting in 1984, The New England Journal of Medicine became the first medical journal to require authors to disclose any financial ties to the subjects they were writing about, and to publicly disclose those ties. Angell opposed a plan to use the New England Journal of Medicine’s brand name to help sell newsletters and conferences – a stance that may have led to her departure as editor within two years.
Last year, Angell produced a memorable two-part series in the New York Review of Books documenting that ineffectiveness of most drugs used to treat mental illness – drugs that are, however, tremendously lucrative for their manufacturers. She said, “I think it is genuinely difficult to know what to believe in clinical research now. There are a lot of grubs crawling around under there.” Dr. Rehlman has written, "We should now allow the medical-industrial complex to distort our health care system to its own entrepreneurial ends, adding that medicine must "serve patients first and sockholders second."
Following the tepid “objectivity” of conventional journalism, the New York Times quotes a number of critics without attempting to ferret out the truth -- a.k.a. "balance." The libertarian-minded law professor Richard A. Epstein is allowed to accuse Relman and Angell of ignorance: “They understand medicine pretty well. The moment they start talking about industry – oy gevalt! They have a deep difficulty understanding the issues…..All they can talk about is greed.”
Yet Times reporter Abigail Zuger declines to probe this accusation or provide any details clarifying how exactly Relman and Angell are supposedly naïve or mistaken. That would presumably enter into a “values zone” that the Times is not prepared to adjudicate – so we readers are left to project our own biases rather than be provided facts.
In this context of faux-neutrality and genteel respectability, it takes courage to step out of line and criticize the big-money players for being scam artists, as Relman and Angell have done. It is is impressive for Relman to have baldly called the health insurance industry “a parasite on the health care system” and to call for a single-payer nonprofit system financed by taxpayers. It is refreshing for Relman and Angell to dismiss “those who choose to believe” that investor-run pharmaceutical companies may have higher ideals than shareholder profit.
The corporate enclosure of health care is one of the most serious human rights abuses of our time, at least in the U.S. It has been notoriously difficult for critics to withstand concerted industry attempts to discredit them, especially if they have medical credentials. Which is why I wish Drs. Relman and Angell many more years to apply their hard-won expertise and courage in the service of independent medicine and better health care.
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