Severed Trust: Why American Medicine Hasn't Been Fixed [Hardcover]

George D. Lundberg (Author), M.D.,George D. Lundberg (Author)

Book Description

ISBN-10: 0465042910 | ISBN-13: 978-0465042913 | Publication Date: March 20, 2001 | Edition: 1

In January 1999 George Lundberg, the highly respected editor of the Journal of the American Medical Association, was fired by the AMA. The stated reason for his dismissal was his rushing into print a study of sex that seemed to support President Clinton's dubious definitions of infidelity. But as the media furor rose to fever pitch, it became clear that this "oral sex debacle" was not Lundberg's first brush with controversy. He had outraged the AMA by charging on "60 Minutes" that doctors were burying their mistakes by not performing autopsies, and he had taken strong stands on such hot-button topics as assisted suicide, gun control, alternative medicine, and abortion. In this no-holds-barred book, Lundberg, now editor in chief of the online medical journal Medscape, speaks out on the crisis in contemporary medicine. He charges that organized medicine has surrendered to an overbuilt and overused political-industrial complex that underfunds prevention, undermines scientific research, and overlooks patients' needs-with disastrous results for doctors and patients alike. High costs and managed care are the least of our problems, says Lundberg: the greatest threat is the pervasive erosion of professional standards. Lundberg's keen analysis of greedy doctors, profit-hungry drug companies, and a corrupted AMA that seeks only to protect vested interests is certain to provoke controversy and stimulate debate.

Editorial Reviews

From Publishers Weekly

It is by now a cultural commonplace to complain about the medical profession and its lack of professionalism, its interest in profits rather than patients and the outrageous mismanagement of the health insurance industry, but this time the criticism comes from a high-profile insider. Physician and former JAMA editor Lundberg (he was fired over a Kinsey Institute study about how people define "sex" that appeared during Clinton's impeachment hearings), along with Stacey (Inside the New Temple: The High Cost of Mistaking Medicine for Religion), contends that quality patient care the primary goal of medicine is a casualty of the current emphasis on medicine as business. Lundberg's writing can be plodding and repetitious, but he makes a strong case. He argues for physicians' greater accountability, contending, for instance, that autopsies no longer performed primarily because doctors fear litigation, particularly if it is determined that their diagnosis was incorrect should become regular medical practice again, as they were just 30 years ago. Lundberg also calls for prevention of disease through standard accepted procedures such as immunization and Pap smears that would be free to patients and paid for by government revenues. Further, he proposes an "economic informed consent," in which patients and physicians "would be provided with the costs of care in advance of receiving or providing services." All in all, Lundberg presents a damning indictment of modern American medicine. (Apr.) Forecast: Basic is backing this with a first printing of 50,000. Lundberg is a controversial and visible figure offering strong opinions on a hot topic. This call for reform should sell very well and Lundberg will be expressing his ideas in a radio satellite tour, appealing to a large number of general readers as well as to patients' rights groups, public policy analysts and other physicians.
Copyright 2001 Reed Business Information, Inc.

From The New England Journal of Medicine

All editors of medical journals are expendable. But the fall, when it comes, is frequently painful and unexpected. Not so for George Lundberg, editor-in-chief of the Journal of the American Medical Association (JAMA) for 17 years: he knew that his sacking in 1999 was inevitable. He had upset too many people for too long a time, and he had courted controversy once too often. His editorial strategy, he has said, was ``to deliberately give [readers] something to complain about.'' Lundberg's wish to tell the truth -- in his words, ``no matter how embarrassing, insulting, or offensive'' -- had eroded the patience of his corporate superiors at the AMA. His editorship had become so vulnerable that, in the end, it collapsed not on a point of principle or integrity but over his decision to publish a study of students' attitudes about oral sex during the public travails of President Bill Clinton. A sublime career tripped in a ridiculous pothole. Lundberg is rueful about the outcome: ``The Monica Lewinsky affair resulted in the loss of my job,'' he writes, ``but not Bill Clinton's.'' Severed Trust provides his first opportunity for serious payback.

Lundberg begins with a series of stinging indictments of the AMA. The present organization has ``lost its credibility'' and lacks leadership; ``has too much money and too little purpose''; and is filled with ``bloated senior staff,'' of which Lundberg was once, of course, a leading member, together with ``a group of pampered voluntary officers.'' Life as an AMA executive involves ``inflated per diems and multiple junkets.'' According to Lundberg, the fact that over two thirds of physicians in the United States refuse to join its ranks proves that the AMA is reviled by its constituency. Lundberg's first dispute with his former employer began after an editorial he wrote about boxing. Declaring that ``boxing is an obscenity,'' he clashed with AMA trustees. From then on he was marked as an irritant.

He watched -- horrified, one is led to believe -- as the AMA adopted staunchly pro-Republican policies, campaigned for the interests of doctors rather than patients, failed to protect the fragile mantle of professionalism surrounding physicians, and preferred to fight within its own committees rather than openly on behalf of the public. His departure, when it came, must have been a blessed relief, rather than a personal tragedy.

Yet this distinguished pathologist, who began his career in medicine as a hospital orderly mopping floors in Mobile, Alabama, is equally scathing about his clinical colleagues in America. For Lundberg, medicine is a moral vocation, but there has been a ``disastrous severance of trust'' during his half-century in practice. The origins of this crisis lie in the ways in which doctors, their egos inflated by the prospect of unbridled affluence, have sought new ways to make money from the sick. As a result, professional standards have plummeted. Too many doctors are incompetent, and they now work in a ``culture of blame and cover up.''

Medicine, in Lundberg's eyes, has been seduced by business. Its corridors of power have been infiltrated by ``money-grubbers.'' Powerful specialists have trumpeted their own interests with the covert intention of filling their pockets with profit, irrespective of the risk to patients. These trends have taken place in a health care system ``guilty of institutional racism.'' Lundberg has written a devastating -- and, to an English doctor all too aware of the deficiencies in the National Health Service of the United Kingdom, shocking -- critique of American values and the medical system it has spawned.

Lundberg wants doctors to take back their profession, and he believes that they can do so only if they provide a package of basic health care to all citizens. When the uninsured are properly protected, he would make all proven preventive services freely available. To achieve such an ambitious goal, rationing must be embraced, not resisted. As unpleasant an idea as this might seem, the benefits -- charitable care, quality assurance, listening to patients' preferences, tackling health inequalities -- would be overwhelming, and a strengthened, independent Institute of Medicine would nurture the profession in a new era of public trust.

Lundberg's polemical memoir has engaging faults. He sometimes attributes too close a connection between pungent editorials or articles published in JAMA and the great turning points in American medical history. He also has an inclination to put himself at the center of national events when, in truth, his role seems to have been rather peripheral (the death of Elvis Presley is one startling example).

But this account of a life and its times has the ring of honesty. For instance, Lundberg confesses to fear about publishing research on medical error. He released one such paper in a December holiday issue of JAMA, which he hoped would be missed by vacationing journalists. It was not. He also recognizes that his expulsion from JAMA was to the journal's eventual advantage. Stronger systems to safeguard editorial independence are now in place. His successor owes him a huge debt.

The personal lesson I take from Severed Trust is that every so often an editor of a medical journal must be sacrificed just to remind doctors why they need editors at all. My feeling is that history will record that George Lundberg was among the best.

Richard Horton, M.B., Ch.B., F.R.C.P.
Copyright © 2001 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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Product Details

• Hardcover: 272 pages
• Publisher: Basic Books; 1 edition (March 20, 2001)
• Language: English
• ISBN-10: 0465042910
• ISBN-13: 978-0465042913
• Product Dimensions: 9.6 x 6.5 x 1.1 inches
• Shipping Weight: 1.5 pounds
• Average Customer Review: 3.8 out of 5 stars  See all reviews (11 customer reviews)
• Amazon Best Sellers Rank: #2,155,268 in Books (See Top 100 in Books)

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Most Helpful Customer Reviews

14 of 14 people found the following review helpful:

5.0 out of 5 stars A Well-Written, Informative, Provocative Book, April 28, 2001

By 

Peter Frishauf (New York, NY USA) - See all my reviews
(REAL NAME)   

This review is from: Severed Trust: Why American Medicine Hasn't Been Fixed (Hardcover)

American medicine is a classic paradox, offering the best of the best alongside an embarrassing failure to provide decent care for millions.

If you have ever puzzled over how this situation came to be, Severed Trust provides an easy-to-understand, well-written explanation. This book is partly the autobiographical odyssey of America's most famous medical editor, George Lundberg, partly a social and political history of American medicine, and partly Dr. Lundberg's vision of the future, detailing what he believes must be done to put our house in order. There are rich and interesting stories alongside important historical information and discussions of social policy issues that in so many other books are......well, just boring.

The son of economically impoverished Alabama schoolteachers, Dr. Lundberg was inspired to enter medicine by his family doctor. He took his first job in medicine mopping floors at a local hospital. After medical school and a distinguished career in pathology; his greatest medical contributions started, first in the 1980s as editor of JAMA, the Journal of the American Medical Association, and, since 1999, as editor in chief of Medscape ... .

In this book, and at JAMA and Medscape, Lundberg relentlessly challenges us to think about issues that hurt the quality, availability, and compassion of care: Why is high-tech medicine, especially at the end of life, often foisted upon patients at great expense, and at times, in nonsensical and inhumane ways? Why are autopsy rates so low in the United States when it has been conclusively proven that autopsies are critical to high quality standards? Can we provide good preventive care for all Americans and if so, why don't we?

Woven through the hard data presented in the book are Lundberg's personal anecdotes from experiences with family, friends, colleagues and articles he has introduced into public discussion and debate.

Lundberg passionately believes that information is powerful medicine, and that by publishing scientifically-sound evidence society will take note, and people, professionals, markets, and politicians will join together to root out bad practices and make the world a better place. The realist in him knows it often doesn't work out that way. But sometimes it does, and the victories, failures, and recommendations are reported in the book with memorable, edgy style (bemoaning the state of autopsies, Lundberg declares "it is time for good pathologists to come out of their clinical labs and spend more time in the morgue.")

Whether you agree or disagree with Lundberg's analyses or proposed fixes, I learned a lot about medicine, health care - and, George Lundberg - from this book, and enjoyed reading it.

Peter Frishauf Founder, [Medscape] Senior Adviser, Medscape, Inc.

(Disclosure: This reviewer recruited Lundberg to Medscape In 1999, after Lundberg was fired by the AMA for publishing the now famous study on the "Is Oral Sex, Sex?" question during the Clinton impeachment hearings)

10 of 10 people found the following review helpful:

5.0 out of 5 stars Excellent, readable critique of today's medical system, April 2, 2001

By 

Robert Ehrlich (florida) - See all my reviews
(REAL NAME)   

This review is from: Severed Trust: Why American Medicine Hasn't Been Fixed (Hardcover)

Dr. Lundberg is a no nonsense, straight talking critic of the current American medical system. I found his historical perpective on how we got to today's, arguably poor, state of medicine fascinating. Dr. Lundberg is highly critical of America's technically excellent but flawed system. He criticizes costly over used medical testing and the highly technical medicine practiced in America today.He compares it with the more caring and cheaper general practitioner sytstem of 30-40 years ago. We want it all from medicine today but at what cost, says Lundberg.Are we all entitled to unlimited expensive services no matter what the cost when we fail to cover 42 million Americans for the most basic services. Is that the right outcome for our highly technical specialized medicine. Where is the preventive medicine? He believes we have a sytem to treat the sick but not prevent illness.

Lundberg blames many forces; greedy doctors, insurance companies, government, consumers, managed care. Some of his criticisms seem overly harsh. For example he would ban any consumer advertising of medical products. This is one solution to high costs he claims.Many older, cheaper midcines do just fine ,he says. What about the fact that American's like to be informed of new treatments. Can't the informed consumer make their own judgements after asking their doctor. Isn't consumer knowledge and advocacy a positive, especially when many of the newer,more effective drugs are resisted by managed care because they are expensive.

Lundberg's critique is a must read for those involved in any phase of the medical system. While many will not agree with his assessment, he does represent a solution: politically difficult but a solution that would be acceptable to many constituencies.

For such a critical issue it is dissapointing how few books exist on this subject. Lundberg's is the best available.

9 of 9 people found the following review helpful:

5.0 out of 5 stars An excellent account of where American medicine is today, March 31, 2001

By 

dissatisfied "ecburtonmd" (New Orleans, LA USA) - See all my reviews

This review is from: Severed Trust: Why American Medicine Hasn't Been Fixed (Hardcover)

Severed Trust provides an insightful view of American medicine intended for a wide audience ranging from patients to policy-makers. Lundberg speaks from experience, intellectualism, and the heart, providing a comprehensive review of many of the current problems inherent in medicine and offers solutions for change. In the past, he often brought attention to many sensitive healthcare issues including addiction, violence, nuclear war, abortion, physician assisted suicide, death and dying, medical mistakes, and inequity of care. In this captivating book, he effectively brings these issues together, highlighting the contribution of each in the complexity of today's medicine. Leaving no stone unturned, he points out the many negative attributes of competing interests from profit to politics and contends that these interests threaten the quality of healthcare. He asserts that a balance exists between medicine as a business (economic incentives) and as a profession and warns that if this delicate balance continues to tip more toward economics and self-interest then society will rise up and take our professional privileges away. Importantly, he also calls attention to the profound $1.2 trillion annual cost of medical care that excludes 40 million uninsured Americans, pointing out the illogical provisions for unnecessary procedures and futile care rather than for preventive services and basic medical care. He proposes many solutions for fixing our healthcare system that deserve serious consideration and finally, he provides a vision for a system that provides better efficiency and good quality of care for all.