By "big medicine", I mean to refer collectively to the large organizations that form much of the medical landscape in the U.S. These organizations are: insurance companies,HMOs,Big Pharma (large pharmaceutical companies ) and corporate not - for -profit hospitals and now ACOs.For economy of key strokes let us call it Bigmed. (Of course, not for profit needs to be in air quotes,)
Increasingly Bigmed controls the practice of medicine. This is not breaking news. Dr.Roy M. Poses has been writing and speaking about this issue for years. In 2003 he published an article describing the results of interviews he had with a number of physicians who expressed this key idea. "Medicine had been taken over by large organizations which did not honor the core values of physicians."
Poses has been prolific and tireless in efforts to address these (and other) threats to health care's core values and many of his commentaries can be read on the blog "Health care Renewal"
Now there are some other physicians joining the discussion.Dr. S. Supri and K. Malone have published an important commentary in the American Journal of Medicine in part striking similar themes to Dr. Poses.
Remember when the economist Alain Enthoven rallied against the power of individual physicians , comparing the situation to that of herding cats , animals notoriously resistance to herding.Well, now the hospitals and clinics and other health care facilities are swarming with herds of docile trained cats who have not only leaned to dutifully bend over computers and enter required "quality" data but also have leaned helplessness.