Dr. Arnold Relman, the pathbreaking, long-time editor-in-chief of the New England Journal of Medicine
, died at his Cambridge, Mass., home last week on his 91st birthday. His wife, Dr. Marcia Angell, also a former NEJM editor-in-chief, said the cause was melanoma.
Under his leadership, NEJM became the first medical journal to require authors to disclose potential conflicts of interest if they owned stock in biomedical companies when they published research that might benefit those firms.
"This was revolutionary," Dr. George Lundberg, former editor-in-chief of the Journal of the American Medical Association, told Medscape Medical News
, where he is now an editor. Disclosure statements "were seen as an invasion of privacy. Many editors and authors didn't think it was anybody's business what they owned or didn't own."
Relman, along with his wife, also was a relentless critic of the profit-driven structure of the U.S. healthcare system, and publicly supported a single-payer system and a delivery system featuring salaried physicians. He once referred to private insurers as “parasites.” He said he appreciated that the Patient Protection and Affordable Care Act
would help more Americans get insurance but saw the legislation as only a partial fix.
Earlier this month, JAMA Internal Medicine
published a Relman article calling for physicians to fight for healthcare reform based on patient-centered care and professionalism. If that kind of reform does not occur, he wrote, "we will end up either with a system controlled by blind market forces or with a system entangled in complicated and intrusive government regulations.”
Relman first had warned of the corrupting influence of a "medical-industrial complex" in an NEJM editorial in 1980. "Bud was never one to let up on a subject," Dr. Jerome Kassirer, who succeeded him as NEJM editor-in-chief, told Medscape Medical News. "If there was no response, he just said it again, and again, and again. He got people to listen. Even when people shrugged him off, they knew what he was saying was right."
In February, Relman published a compelling account
in the New York Review of Books of his healthcare experience last summer after suffering near-fatal injuries from a fall down the stairs at his home. He praised the quality of the acute care he received at Massachusetts General Hospital but was more critical of the physician and nursing care he received at the rehabilitation facility where he was later transferred. Overall he was critical of the lack of coordination in his care, the excessive amount of time doctors spent on computers and looking at data, and the high costs.
“Given the limited life expectancy of someone my age, is it justified to spend hundreds of thousands of dollars to extend a nonagenarian's life a little longer?” he wrote in his February article. “That is a question needing more discussion than I can undertake here. I would hardly be an unbiased voice, since it was my life that was at stake, and I was very glad it was saved.”
As NEJM's editor-in-chief from 1977 to 1991, Relman helped increase the journal's influence and circulation, from 167,000 in 1976 to 233,000 in 1990. The NEJM issued a statement saying "the medical community and the nation have lost a strong leader. His legacy will forever remain a part of the New England Journal of Medicine."
Relman earned his medical degree at Columbia University in New York City at age 22 and soon began publishing his research in peer-reviewed journals, becoming an authority on kidney function.
He practiced and taught at Boston University School of Medicine, the University of Pennsylvania School of Medicine, and finally Harvard Medical School, where he was an emeritus professor at the time of his death.
He served as 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 and Angell received a 2002 George Polk Award for their New Republic article examining how drug companies spend more of their profits on advertising and lobbying than on drug research and development.
Just before he died, Relman received the galleys of a review he wrote for the New York Review of Books of a book on healthcare spending.
In his February article, he wrote that what helped in his recovery from his near-fatal accident last year was “I wanted to stay around as long as possible to see what was going to happen to my family, to the country, and to the health system I was studying so closely. Perhaps I was too engaged in life to allow death to intrude right then.”