Mindbend

It was hard to believe, but the message he’d gotten during the last stages of Jennifer’s labor had been correct. Sitting among a group of expectant fathers was his own, Dr. David Schonberg.

Dr. Schonberg met his son as soon as he entered the room.

“Hello, Adam,” he said in his usual cool manner.

“Hello, father,” said Adam.

Dr. Schonberg adjusted his glasses higher on his nose.

“What’s it like being back in medical school?”

“Just fine,” said Adam. “I’m so glad to be back. I’ve hardly minded the catch-up work.”

“That’s good to hear,” said Dr. Schonberg. “How’s Jennifer?”

Adam stared at his father. It was the first time the man had ever called Jennifer by name.

“She’s just fine,” answered Adam.

“And what about the baby?”

“The baby’s a healthy, beautiful boy,” said Adam.

To Adam’s utter astonishment he saw something he’d never seen before: tears in his father’s eyes. Before the shock could register, his father’s arms were around him, hugging him. Another first. Adam hugged back. Tears formed in Adam’s eyes as well, and the two men stood there, holding each other for so long that some of the soon-to-be fathers began to stare.

Finally, a somewhat embarrassed Dr. Schonberg pushed Adam back, but lovingly held onto his arms. Each looked at the other’s tears, then both laughed.

“I wasn’t crying,” said Dr. Schonberg.

“Neither was I,” said Adam.

“You know what I think?” said Dr. Schonberg.

“What?” asked Adam.

“I think we’re both lousy liars.”

“I think I’d have to agree.”

AUTHOR’S NOTE

Since I graduated from medical school in 1966, I have heard the term “crisis in medicine” so often that it conjures up the allegory of the shepherd boy who cried wolf too many times. But until now the crises have all been voiced by particular interest groups and were often contradictory: too few hospital beds, too many hospital beds; not enough physicians, too many physicians. It was enough to make anyone confused and apathetic.

But now I have come to believe that “crisis in medicine”

is applicable in a truly general sense. Unfortunately, because so many people have cried wolf in the past, the media have only just begun to take note of this very real crisis.

What we are witnessing today is the gradual but quickening pace of the intrusion of business into medicine. It must be understood that the corporate mentality of the balance sheet is diametrically opposed to the traditional aspects of altruism that have formed the foundation of the practice of medicine, and this dichotomy augers disaster for the moral and ethical foundations of the profession. Big Business views the medical field as a high-cash-flow, high-profit, low-risk, and low-capital investment industry that is now particularly ripe for takeover.

Evidence of this shift toward business interests in the medical field is reflected in the newly interlocking ownership of proprietary (for profit) hospitals and nursing home chains, medical suppliers, and a deluge of other health-care organizations like dialysis centers, surgi-centers, etc. Even research has gone in the direction of business as evidenced by the new biotech companies.

Response to this activity has been surprisingly slight, despite the insidious effect it has on the practice of medicine. Professional journals have viewed the process with curious academic disinterest, doctors have either joined the entrepreneurial bandwagon or ignored it, the public has remained silent, and the media have only just begun to run articles sounding the alarm. It is my hope that Mindbend will help focus public attention. By couching the problem in an emotional framework, it brings the process into personal perspective and allows the reader to understand the implications of the situation through identification with the main character, which I believe is one of the key values of fiction.

For me, the realization of the intrusion of business into medicine came with a letter I received from a hospital, informing me that its census was low and that I should admit more patients for surgery, as if I had a group of people in the wings who were being denied appropriate operations. That letter, more than any other experience, made me realize that our medical system had inadvertently been constructed to depend upon and reward overutilization of facilities and services, thereby fostering its own rising costs. No wonder businessmen became interested.

For Mindbend I chose the drug industry as the focal point not because it has been any worse than any other group, but because it has been around longer than most businesses associated with medicine and it exerts a powerful and growing influence. The important point is that the drug firms are corporations which do not exist for the public weal, no matter how much they try to convince the public otherwise.

Their goal is to provide a return on their investors’ capital.