Marianne Matthews

My husband is the one with the sexy job. He’s a jazz musician. So I’m not surprised when friends and family spot a news article about the world of jazz and send it our way. It might be a review of a new CD or an obituary of some “jazz great.” People read it, clip it, and send it. After all, everyone wants to be a part of the “scene.”

But I was surprised recently when my job inspired a neighbor to clip a cover article from The New York Times. The news-clipping offering told me two things: This is a man who truly cares about other people (I didn’t even think he knew what line of work I was in!). But the gesture also told me: My neighbor is worried about today’s complex—and sometimes contradictory—health care system. In fact, the article came to me with an impassioned delivery.

Titled “Weighing the Costs of a Look Inside the Heart” (NYT, June 29, 2008), the feature paints a disturbing picture of profit-minded physicians. It’s about physicians’ financial interests when it comes to CT scans of the heart. According to the report, “CT scans, which are typically billed at $500 to $1,500, have never been proved in large medical studies to be better than older and cheaper tests. And they expose patients to large doses of radiation, equivalent to at least several hundred x-rays, creating a small but real cancer risk.” The article goes on to say, “Increasing use of the scans ? is part of a much larger trend in American medicine. A faith in innovation, often driven by financial incentives, encourages American doctors and hospitals to adopt new technologies even without proof that they work better than older technologies.”

What is my intelligent, but skeptical, neighbor to make of this reporting by one of the nation’s most respected publications? It raises the question: Are physicians ripping us off with unnecessary testing?

For 3 weeks, I thought about ways to respond to this friend. Should I tell him about all the dedicated cardiologists I know? About how hard the manufacturers work to develop breakthrough technologies? Or am I just naive? Should I respond at all? Is it in my job description as editor to respond?

Then there was a turn of events for my neighbor. He was suddenly thrust into the role of caregiver. A loved one had a frightening emergency and underwent all kinds of medical tests—imaging and invasive. Now my neighbor was not only skeptical of the system, but more vulnerable than ever before. Patients and caregivers should not be made to feel like victims of a profit system on top of dealing with a health crisis.

So this is my response: In today’s complicated, high-tech world, it is tough to trust any “system.” Systems don’t always work well; systems break down; sometimes, they fail us. But it is up to us (even if only because it gives us hope) to make an effort to trust people. It boils down to individual responsibility.

Be it journalist or physician, we must seek out the individuals who stick to their job descriptions and are willing to be held accountable. Consider The New York Times reporters. Their feature delivers fair, accurate, balanced facts. They examine both sides of the issue, citing physicians who are driven by a higher incentive, and say, “For too many people, the scans are inappropriate.” In short, not every physician is driven by profit.

And physicians, well, they must adhere to a rather difficult job description: “I will apply, for the benefit of the sick, all measures [that] are required, avoiding the twin traps of overtreatment and therapeutic nihilism.”* An uneasy—and sometimes slippery—tightrope walk.

Marianne Matthews, editor