Jerome P. Kassirer is a caring physician. At age 72, he has watched medical care change drastically, mostly for the worse despite development of amazing technology...
Jerome P. Kassirer is a caring physician. At age 72, he has watched medical care change drastically, mostly for the worse despite development of amazing technology that can save lives. So, while editor of the influential New England Journal of Medicine, he blew the whistle on unethical behavior. His organizational superiors fired him. Refusing to be silenced, Kassirer’s latest salvo is his book, “On the Take.”
Unlike many authors, Kassirer decided to share his dismay only as a last resort: “Patients should not have to worry about the integrity of their doctors,” he says. “They are already baffled by the choice of medical insurance, incapable of navigating the system to straighten out their medical bills, beset by increasingly expensive copayments, and dismayed about limitations in their choices of doctors and hospitals. I am reluctant to lay on still another encumbrance, yet for individual patients the consequences of their doctors’ financial connections to HMOs and industry can be far-reaching.”
Although Kassirer touches on lots of problems within the medical-care realm, this book is narrowly focused. It is primarily about greedy physicians who compromise the quality of patient care to earn as much money as possible. Suppliers of that money include largely for-profit HMOs that seem to have strayed from the goal of preventive medicine, medical device manufacturers and pharmaceutical companies.
While Kassirer’s patient-friendly book is narrowly focused, a new book by an award-winning investigative journalist duo is sweeping in its scope. For instance, Donald L. Barlett and James B. Steele tell the story of Milliman USA, a Seattle-based consulting company, and Dr. Thomas G. Cleary, head of pediatric infectious diseases at the University of Texas, Houston, Medical School.
Six years ago, Cleary noticed hospital-stay guidelines for children published by nonmedical consultants who seemed to care more about saving money for insurance companies than about the wellness of young patients. Barlett and Steele explain how the consulting firm, Milliman USA, came to specialize in drafting such guidelines for the insurance industry. The Milliman guidelines for children’s hospital stays listed Cleary as a contributor. But Cleary had played no role in endorsing the guidelines, which, according to Barlett and Steele, the doctor considered “outrageous.”
Cleary had seen a draft of the guidelines because one of his colleagues at the Houston medical school, Dr. Robert Yetman, participated in the drafting. In return, Milliman had retained Yetman as a consultant and made a $100,000 donation to the medical school.
Appalled at the nonspecific nature of the guidelines, Cleary worried that if followed they might lead to unnecessary deaths of children. He demanded that Milliman omit his name from the manual, then helped engineer the disassociation of the medical school’s pediatrics department from the guidelines.
Such guidelines motivated by bottom-line considerations are being adopted across the nation, despite the efforts of doctors such as Cleary. Their adoption by insurers against the advice of medical professionals is just one portion of this compelling exposé in book form. Barlett and Steele present Milliman’s side of the controversy, quoting an unnamed executive there that cost-cutting by health insurance companies through the use of guidelines is “the right idea at the right time.”
Physicians do not oppose guidelines per se, Barlett and Steele explain. Rather, Milliman-drafted guidelines call “for much shorter hospital stays than many doctors believe are necessary to treat certain conditions,” according to the investigative duo. “For its part, Milliman insists the guidelines are based on reviews of scientific literature, medical charts, consultations with physicians and up-to-date evidence.”
Barlett and Steele conducted their first investigation together 34 years ago, after a Philadelphia Inquirer editor teamed them. Years later — after dozens of stunning newspaper projects, exposés for Time and its sister magazines, plus best-selling books — Barlett and Steele remain two of the most talented, controversial investigative journalists in U.S. history.
Among the problems examined by Barlett-Steele: unexpectedly high death rates; incompetent or impaired doctors, laboratory technicians and nurses; lack of insurance coverage for tens of millions of Americans; untrained clerks at insurance companies and health maintenance organizations refusing to approve necessary medical procedures; overcharges to patients by hospitals and pharmaceutical companies; overloaded emergency rooms; relentless bill collectors; unsafe drugs; uncaring or hog-tied state and federal government regulation; legislators who provide themselves superb care while refusing to approve meaningful reforms; ownership of health-care facilities by investors who buy and sell to maximize profit.
Part of the Bartlett-Steele formula is relentless, long-term reporting that includes human sources and documents undiscovered by other journalists. Another part is writing with anecdotes, analogies and metaphors that elicit reactions like “Wow!” and “Now I finally understand this issue clearly.” They are not shy about recommending fresh potential solutions because they have become experts during the reporting and writing.
Their solutions and solutions suggested by Kassirer sometimes overlap, a reformer consensus if you will. The overriding question now is whether the big societies like the American Medical Association, federal regulators such as the Food and Drug Administration, the U.S. Congress, state legislatures and state-level physician licensing agencies will act in the public interest.
Steve Weinberg is a freelance investigative reporter in Columbia, Mo.