Arnold Relman, Medicine’s Long-time Conscience, Dies at 91

Arnold “Bud” Relman, MD, a pace-setting former editor of the New England Journal of Medicine (NEJM), died June 17 of cancer at the age of 91, just weeks after another journal published his latest call for physicians to press for healthcare reform in the name of patient-centered care and professionalism. If that kind of reform did not occur, “we will end up either with a system controlled by blind market forces or with a system entangled in complicated and intrusive government regulations,” Dr. Relman wrote in an article published online June 2 in JAMA Internal Medicine.

Dr. Relman was editor-in-chief of the NEJM from 1977 to 1991. In addition to making the journal a forum for healthcare policy debate, he helped enlarged its influence. Its circulation, Dr. Kassirer reported in 1991, increased from 167,000 in 1976 to 233,000 in 1990, while the number of unsolicited manuscript rose 47%. At the same time, Dr. Relman instilled an editorial purity at the NEJM in the 1980s that eventually became the standard for medical journal publishing. He was part of a seminal group at that time called the International Committee of Medical Journal Editors that sought to strengthen the scientific integrity of published research.

“He pointed out to all of us that we needed to think about the motivation of authors and funding sources,” said George Lundberg, MD, then editor of the Journal of the American Medical Association.

Under Dr. Relman’s direction, the NEJM became the first medical journal to require that study authors disclose any financial conflicts of interest. At the NEJM, Dr. Relman began hammering away at the profit motive in healthcare, which he considered outsized and harmful. His disfavor fell on for-profit hospitals, for-profit nursing homes, and health insurers, among other market players. More than anything, Dr. Relman worried about the effect of the medical-industrial complex on his profession.

“Will medicine now become essentially a business, or will it remain a profession?” he asked in a 1991 lecture to the Massachusetts Medical Society later published in the NEJM.
The NEJM issued a statement today declaring that “the medical community and the nation have lost a strong leader.”

“His legacy,” the publication said, “will forever remain a part of the New England Journal of Medicine.”