SEVERED TRUST

A worm’s-eye view of why American medicine is in such bad shape, and what can be done to heal it.

Lundberg made national news a couple of years back for being fired as editor of the Journal of the American Medical Association. He was removed from his influential post not, he recalls, for his activist stand on matters such as nuclear weaponry and universal health-care coverage, but because he had been perhaps a little too openly critical of American hospitals’ increasing failure to perform autopsies on patients who had died within their walls. Only about 10 percent of such deaths are followed by autopsies, which, Lundberg argues, constitutes a lapse in quality control. “Think of it this way,” he writes. “Where would teaching be without testing students? Where would banking be without auditors? . . . Where would airline pilots be without air traffic controllers? That is where medicine would be without the autopsy. It is the one place where truth can be sought, found, and told without conflict of interest.” Now editor of an online medical-information service, Lundberg still has plenty to say about autopsies, one of many subjects he covers in this highly critical study. He also has much to say about the transformation of American medicine into a provider of cures and not care, wedded to enormously complex and expensive technology and to an inflationary, self-serving system where staggering costs are the unquestioned order of the day. “The system,” he writes, “is set to jump into interventions, some entailing considerable risks, while it largely neglects giving attention, comfort, and reassurance to patients.” He proposes reining in surgical interventions that have become too freely used (such as the coronary artery bypass graft, as commonly dispensed as aspirin, it seems) and banning direct-to-consumer medical advertising, which, he believes, squanders health-care dollars and commercializes a profession that, in the end, ought to be above mere dollars.

Incendiary stuff—and fuel for those who urge reforms in the health-care system.