Tuesday, April 04, 2006

Absolutely Blistering

The United States of America is a young country.  So young, in fact, that one may reasonably doubt whether it has any institutions that legitimately can be called "venerable," given that part of the definition of something that is venerable, is that it must must be old.  If, however, one allows that this young whippersnapper of a country can indeed have something that is venerable, then certainly, the New England Journal of Medicine would qualify.  It was founded by Dr. John Collins Warren in 1812 as a quarterly called The New England Journal of Medicine and Surgery.

The history of medicine is replete with time-honored traditions.  Among these is included a certain elusive quality of pretentiousness that is somehow acceptable, despite the air of exclusivity it engenders.  This is true because, as irritating as pretentiousness is, it does not sink to the level of a deadly sin, when it subserves a truly noble purpose.  

A quick examination of their website confirms this nobility of purpose.  There are no advertisements, although it is quite likely that there would be many suitors.  The editors chose to spurn that quick profit, in return for both the perception of impartiality, and some editorial freedom.  Editorial freedom, after all, is a valuable commodity.  It is somewhat surprising, perhaps, that despite that freedom, the authors seem to make use of such freedom only rarely.  It is even more rare, that they turn their editorial blunderbusses toward the federal government.  After all, the Journal is penned by academic physicians.  Federal research grants are their lifeblood, even though the government doles out the grants like tiny flecks of gold leaf, being given to a young apprentice at an artisan's guild.  "That's all you get, now run along and make something worthwhile out of it!"

Imagine, if you can, the depth and breadth of my astonishment, when I read the following in those venerable pages:
Despite its youth, the Medicare drug benefit is already chronically ill. But with extensive rehabilitation, it could go on for years, albeit with impaired functional capacity. Debate continues over whether its early spasticity was caused by inept management of its birth or a genetic disorder present at its creation. Proponents of the first explanation suggest that Medicare and its private insurers were not ready for the millions of applicants and hundreds of millions of prescriptions that poured in early in January, in a flood that they were ill prepared to handle. The layer of insurance companies inserted into the process in the name of efficiency exacerbated the confusion. An administration and Congress guided by Ronald Reagan's principle that "government is not the solution to our problem; government is the problem" put his vision into practice in a chillingly convincing way.
Oh my.  "Chillingly convincing."  That is from a Perspective article about the new Medicare Part D prescription drug benefit.  Read the whole thing.  It is available to the public here.