Dr.
Arnold S. Relman, who abandoned the study of philosophy to rise to the
top of the medical profession as a researcher, administrator and
longtime editor of The New England Journal of Medicine,
which became a platform for his early and influential attacks on the
profit-driven health care system, died at his home in Cambridge, Mass.,
on Tuesday, his 91st birthday.
His wife, Dr. Marcia Angell, said the cause was melanoma.
Dr.
Relman and Dr. Angell filled top editorial posts at the journal for
almost a quarter-century, becoming “American medicine’s royal couple,”
as the physician and journalist Abigail Zuger wrote in The New York Times in 2012.
The
couple shared a George Polk Award, one of journalism’s highest prizes,
for an article in 2002 in The New Republic that documented how drug
companies invest far more in advertising and lobbying than in research
and development.
His
extended critique of the medical system was just one facet of a long
and accomplished career. Dr. Relman was president of the American
Federation for Clinical Research, the American Society of Clinical
Investigation and the Association of American Physicians — the only
person to hold all three positions. He taught and did research at Boston
University, the University of Pennsylvania, Oxford and Harvard, where
he was professor emeritus of medicine and social medicine.
Early in his career, he did pioneering research on kidney function.
He
was also editor of The Journal of Clinical Investigation, a bible in
its field, and he wrote hundreds of articles, for both professional
journals and general-interest publications. Days before he died, Dr.
Relman received the galleys of his final article, a review of a book on
health care spending for The New York Review of Books, to which he was a
frequent contributor.
In
a provocative essay in the New England journal on Oct. 23, 1980, Dr.
Relman, the editor in chief, issued the clarion call that would resound
through his career, assailing the American health care system as caring
more about making money than curing the sick. He called it a “new
medical-industrial complex” — a deliberate analogy to President Dwight
D. Eisenhower’s warning about a “military-industrial complex.”
His
targets were not the old-line drug companies and medical-equipment
suppliers, but rather a new generation of health care and medical
services — profit-driven hospitals and nursing homes, diagnostic laboratories, home-care services, kidney dialysis centers and other businesses that made up a multibillion-dollar industry.
“The
private health care industry is primarily interested in selling
services that are profitable, but patients are interested only in
services that they need,” he wrote. In an editorial, The Times said he
had “raised a timely warning.”
In
2012, asked how his prediction had turned out, Dr. Relman said medical
profiteering had become even worse than he could have imagined.
His prescription was a single taxpayer-supported insurance system, like Medicare,
to replace hundreds of private, high-overhead insurance companies,
which he called “parasites.” To control costs, he advocated that doctors
be paid a salary rather than a fee for each service performed.
Dr.
Relman recognized that his recommendations for repairing the health
care system might be politically impossible, but he insisted that it was
imperative to keep trying. Though he said he was glad that the health care law signed by President Obama in 2010 enabled more people to get insurance, he saw the legislation as a partial reform at best.
The
health care system, he said, was in need of a more aggressive solution
to fundamental problems, which he had discussed, somewhat
philosophically, in an interview with Technology Review in 1989.
“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 told the review. “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.”
Dr.
Relman edited The New England Journal of Medicine from 1977 to 1991.
Founded in 1812, it is the oldest continuously published medical journal
in the world, reaching more than 600,000 readers a week. Dr. Angell was
the editor in 1999 and 2000.
When
he took the journal’s helm, interest in health news was booming, and
newspapers and magazines competed to be first in reporting new
developments. One policy he instituted was to ask general-interest
publications not to disclose a forthcoming article in advance, a request
almost always honored, albeit sometimes grudgingly.
He
also began requiring authors to disclose any financial arrangements
that could affect their judgment in writing about the medical field,
including consultancies and stock ownership.
Dr.
Relman and Dr. Angell met when she was a third-year student and he was a
professor at Boston University School of Medicine. They published a
paper on kidney disease together in The New England Journal of Medicine,
then did not see each other for years.
After
he became the journal’s editor, he asked her to come on board as an
editor, which she did, abandoning her career as a pathologist. They
began living together in 1994 — both were divorced by then — and married
in 2009.
They
became the ultimate medical power couple, not least because they were
gatekeepers for one of the world’s most prestigious medical journals.
Their outspoken views further distinguished them.
“Some
have dismissed the pair as medical Don Quixotes, comically deluded
figures tilting at benign features of the landscape,” Dr. Zuger wrote in
The Times. “Others consider them first responders in what has become a
battle for the soul of American medicine.”
Arnold
Seymour Relman was born on June 17, 1923, in Queens (in an elevator,
according to Dr. Angell) and grew up in the Far Rockaway neighborhood.
His father was a businessman and avid reader who inspired his son’s love
of philosophy. His mother nicknamed him Buddy, and friends called him
Bud the rest of his life.
He
skipped grades in school and graduated at 19 from Cornell with a degree
in philosophy, but he chose not to pursue the field because it “seemed
sort of too arcane,” his wife said. He earned a medical degree from the
Columbia University College of Physicians and Surgeons at 22. His first
marriage was to Harriet M. Vitkin.
In
addition to Dr. Angell, he is survived by his sons, David and John, and
a daughter, Margaret R. Batten, all from his first marriage; his
stepdaughters, Dr. Lara Goitein and Elizabeth Goitein; six
granddaughters; and four stepgrandsons.
Last
June, Dr. Relman fell down a flight of stairs and cracked his skull,
broke three vertebrae in his neck and broke more bones in his face. When
he reached the emergency room, surgeons cut his neck to connect a
breathing tube. His heart stopped three times.
“Technically, I died,” he told The Boston Globe.
He
went on to write an article about his experience for The New York
Review of Books, offering the unusual perspective of both a patient and a
doctor.
“It’s both good and bad to be a doctor and to be old and sick,” he told The Globe.
“You
learn to make the most of it,” he added. “Schopenhauer, the German
philosopher, said life is slow death. Doctors learn to accept that as
part of life. Although we consider death to be our enemy, it’s something
we know very well, and that we deal with all the time, and we know that
we are no different. My body is just another body.”
Correction: June 23, 2014
An earlier version of this obituary misstated where Dr. Relman and his wife, Dr. Marcia Angell, met. They met when she was a student and he was a professor at Boston University School of Medicine, not Harvard Medical School. Because of an editing error, the earlier version also misstated the dates of Dr. Relman’s tenure as editor of The New England Journal of Medicine. He held the post from 1977 to 1991, not from 1977 to 2000. (Dr. Angell was editor in 1999 and 2000.)
An earlier version of this obituary misstated where Dr. Relman and his wife, Dr. Marcia Angell, met. They met when she was a student and he was a professor at Boston University School of Medicine, not Harvard Medical School. Because of an editing error, the earlier version also misstated the dates of Dr. Relman’s tenure as editor of The New England Journal of Medicine. He held the post from 1977 to 1991, not from 1977 to 2000. (Dr. Angell was editor in 1999 and 2000.)
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