The Medical-Industrial Complex

This is the classic first article about the medical-industrial complex.  It first appeared in the New England Journal of Medicine in 1980.   It is an imporant article, maybe needing to be updated.  My own feeling is that the concept of the Medical-Industrial-Academic Complex is more important -- but academics control what gets into our journals.  The most prestigious journals tend to benefit greatly from advertising dollars (can skew content) and the authors of scholarly articles are academics.  That focuses the literature on what academics feel is important.  Thus they report on diseases much more than illnesses.

The Medical-Industrial Complex
Arnold Relman
NEJM 1980; 303:963-970

ABSTRACT: The most important health-care development of the day is the recent, relatively unheralded rise of a huge new industry that supplies health-care services for profit. Proprietary hospitals and nursing homes, diagnostic laboratories, home-care and emergency-room services, hemodialysis, and a wide variety of other services produced a gross income to this industry last year of about $35 billion to $40 billion. This new "medical-industrial complex" may be more efficient than its nonprofit competition, but it creates the problems of overuse and fragmentation of services, overemphasis on technology, and "cream-skimming," and it may also excercise undue influence on national health policy. In this medical market, physicians must act as discerning purchasing agents for their patients and therefore should have no conflicting financial interests. Closer attention from the public and the profession, and careful study, are necessary to ensure that the "medical-industrial complex" puts the interests of the public before those of its stockholders

The private health-care industry is primarily interested in selling services that are profitable, but patients are interested only in services that they need, i.e., services that are likely to be helpful and are relatively safe.

In the health-care marketplace the interests of patients and of society must be represented by the physician, who alone has the expertise and the authority to decide which services and procedures should be used in any given circumstance.

We should not allow the medical-industrial complex to distort our health-care system to its own entrepreneurial ends.