NEJM Blasts “Crusade,” Omits that Its Former Editor Launched It

By MICHAEL MILLENSON A blistering attack by the national editor of the New England Journal of Medicine against the “less is more” movement in medicine omitted that the publication’s former editor-in-chief played a foundational role in popularizing the idea of widespread medical waste. The commentary in late December by Dr. Lisa Rosenbaum, “The Less-Is-More Crusade – Are We Overmedicalizing or Oversimplifying?” has attracted intense attention.  Rosenbaum berates a “missionary zeal” to reduce putative overtreatment that she says is putting dangerous pressure on physicians to abstain from recommending some helpful treatments. She also asserts that the research by Dartmouth investigators and others who claim 30 percent waste in U.S. health care, in which she once fervently believed, is actually based on suspect methodology. What Rosenbaum fails to mention is that the policy consensus she seeks to puncture – that the sheer magnitude of wasted dollars in U.S. health care offers “the promise of a solution without trade-offs” – originated in the speeches, articles and editorials of the late Dr. Arnold Relman, the New England Journal’s editor from 1977 to 1991. Waste’s “fundamental cause is doctors”? Although Relman consistently blasted a variety of culprits who “commercialized” medicine, he was clear in a 1985 article for the National Academy of Sciences that “more prudent choices by physicians” would substantially reduce costs. A “crusade...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Economics Physicians Michael L. Millenson NEJM Source Type: blogs