Severed Trust: Why American Medicine Hasn’t Been Fixed

George Lundberg, you recall, who had been editor of JAMA for 17 years, was fired by the American Medical Association (AMA) in 1999 because he published, during the impeachment trial of President Clinton, an unsolicited, peer-reviewed study from the Kinsey Institute in which 59% of an Indiana college student sample said they did not consider having had oral sex as having “had sex.” Lundberg comments, a bit grandly, on the “irony” (p. xii) that “the Monica Lewinsky affair resulted in the loss of my job, but not Bill Clinton’s” (p. xii). Whether his dismissal could be laid to a puritanical standard to which Surgeons General and medical editors but not network television is held, or a partisan political offense, is not discussed, but the book does clearly convey that the life of a medical journal editor is far from a stuffy and scholarly refuge from perils of the front lines of practice. In fact, all but one of his 13 predecessors had been “fired, forced to resign or retired under pressure” (p. x), and Lundberg always knew that at some point he too would fall to some conflict.

The book is not intended as autobiography but as a “medical memoir…of what has happened to medicine during the last 50 years” (p. 1). It seems to be one man’s attempt to seek moral direction amid buffeting by political winds and warring interests. Lundberg was an Army pathologist for 11 years. As the joke goes, the pathologist knows everything but too late, and a pathologist’s modus operandi is suited to the editor’s evaluative task. Lundberg presents his opinions on complex issues as judgment calls. In a speech at the Wharton benefit for the Columbia consultation-liaison service on May 15, 2000, he peppered his animated talk with apothegms such as, “There is no alternative medicine—only medicine” and, “The plural of anecdote is not data.” Despite his attitude about anecdotes, he presents one in his book about having had back pain before a talk that was cured in a half hour by an acupuncture needle in his ear. He distinguishes between his early bias against chiropractic theory and evidence that practicing chiropractors may ease back pain. He published a 10-year-old schoolgirl’s project that debunked “therapeutic touch” (pp. 116–117), however, incurring the ire of the 70,000 nurses trained in it, and finds homeopathy “preposterous and totally absurd” (p. 118).

Lundberg contends that Medicare hospital funding should be tied to a 30% autopsy rate so we can learn from our mistakes. He links what he complains about in modern medicine’s approach to end-of-life care to the right-to-life movement and argues for assisting patients to seek a humane death by simply refusing fluids rather than the “ghastly machines” (p. 240) of Jack Kevorkian. He recounts the more old-fashioned handling of the deaths of each of his parents as “letting nature take its course” (p. 220). Other issues taken up, all with ethical implications, are physician influence group seminars put on by the pharmaceutical industry and abortion, on which he took a “neutral editorial position” (p. 224), although he opposed federal intervention in the practice of late-term abortion, which the AMA went along with. He opposes boxing, extreme fighting, and handguns and favors a treatment approach to illegal drugs.

The book is breezily written, easily read, and, of course, well edited. It provides an annotated history of the important issues in many recent debates in mainstream medicine, all of which have a psychiatric dimension. There is a regrettable lack of psychiatric citation or even the appearance of the word “psychiatry” in the index. The words “mental health” appear twice on page 74 in the context of insurance coverage being dropped. There is much discussion of insurance issues, favoring coverage for prevention and catastrophe.

Lundberg is now Editor-in Chief and Executive Vice President of Medscape, the leading Internet medical information provider, and he has cogent things to say about ethics, payola, and privacy in cyberspace.