Written by Lisa Plymate, MD, Co-Chair of the National Physicians Alliance FDA Task Force. Dr. Plymate practices primary care internal medicine and geriatrics in Seattle, Washington.
Even though he had the fortune to live a full life of 91 years and we the great fortune of learning with him for many of those years, the medical community feels tremendous sadness at losing Arnold Relman’s wise voice in our midst.
Arnold Relman saw our beleaguered health care system in historical context and conceived a vision of a far better future for both health care professionals and for our patients.
Already an M.D. at 22, he had a head start examining our system. His long career provided the ability to view it over a lengthy period of time. While at the helm of the New England Journal of Medicine, which he edited for an astonishing 23 years, he introduced a profoundly important policy: the requirement that authors disclose any financial conflicts of interest.
In his landmark 2007 book, A Second Opinion: Rescuing America’s Health Care, Dr. Relman described his “plan for universal coverage serving patients over profit.” He offered a clear, concise account of the how our health care system had evolved into a profit-driven “medical-industrial complex.” His multifaceted solution took into account issues of both coverage and cost: a single-payer model, supported by taxes, and the elimination of fee-for-service medicine in favor of a salary structure for physicians. He argued for physicians working in multispecialty clinics, with primary care constituting 50% of the staff. He was a pioneer, and A Second Opinion is a must-read for anyone interested in transforming our health care delivery system.
His partnership with Marcia Angell, who also became an editor of the NEJM, enriched both their lives and also ours in medicine. Dr. Relman continued to write until a few days before his death. In his February 6, 2014 article in The New York Review of Books, Dr. Relman chronicles his miraculous recovery from a fall in which he suffered an intracranial hemorrhage, cervical spine and facial fractures, and cardiac arrests. Through this experience he required intubation with a tracheostomy.
Reflecting on the crisis as a physician-turned-patient, he expressed gratitude for much of his care, particularly in the acute phase. He knew he survived because of superb emergency treatment and rehabilitative care and he recognized that his desire to live played a crucial role in his recovery. He knew he wanted to “stay around as long as possible to see what was going to happen to the health care system I was studying so closely.”
We will miss his voice and his guidance. In Dr. Relman’s memory, may we carry on his pursuit of a more just and humane health care system in this country.