This first week traced how medicine in America was deliberately shaped by forces that claimed to elevate care while narrowing who had access to it. The American Medical Association has issued a formal apology for undermining Black medical schools, women’s institutions, and holistic traditions, but apologies without structural change serve more as public relations than repair. Holistic medicine remains marginalized not because it lacks evidence, but because plants and preventive approaches cannot be patented.
Profit continues to define legitimacy, even though antibiotics, surgery, and plant-based treatments all hold proven value. They are not opposites. What remains harmful is the refusal to recognize their coexistence and the absence of meaningful redress for generations of exclusion.
The week began with the AMA’s role in shaping education through the Flexner Report of 1910. While it did raise standards, it also shut down nearly all Black and women’s medical schools. Rockefeller funding pushed medicine toward a laboratory model, sidelining other approaches and cementing inequity into the foundation of American healthcare. Universities then deepened their ties to industry after the Bayh–Dole Act of 1980 allowed institutions to patent publicly funded discoveries. Innovation accelerated, but entanglement followed. By 2007, sixty percent of department chairs reported financial ties to industry, and continuing medical education was dependent on nearly one quarter of its revenue from commercial support.
Clinical research too often became a marketing instrument. Negative results went unpublished, ghostwriting was used in journals, and seeding trials blurred the line between experiment and sales. The consequences were not abstract. Vioxx was linked to tens of thousands of deaths. Opioid marketing fueled an epidemic that continues to devastate families. Insulin pricing remains so high that rationing has led to preventable deaths each year. Lobbying and advertising reinforced the system. Industry spending on lobbying reached hundreds of millions in 2025, while drug advertising exceeded 10B in 2024. Utilization patterns shifted not because of patient need but due to marketing pressure, eroding the ethical principles of autonomy, nonmaleficence, and justice.
Regulation also became compromised. The FDA now funds most of its drug review budget through user fees. Faster approvals followed, but so did dependency. The revolving door between regulators and industry undermined independence, and dangerous drugs such as Vioxx stayed on the market too long. Opioids received approvals and promotions in an environment tilted by these structural conflicts. At the level of payment, the AMA’s Relative Value Scale Update Committee determined which services were financially rewarded. Highly technical procedures received greater value, while primary care and prevention were undervalued. The result was shorter visits, unchecked bias, and patients stripped of dignity. Preventable deaths from sepsis, heart attacks, maternal complications, diabetes, and asthma reflected the consequences of treating patients as billable units. Defensive medicine and malpractice payouts added billions more to the toll.
Correcting this course requires more than patches on a broken system. It demands structural change. Transparency must become the baseline, with all clinical trial data released in full to prevent selective reporting. The financial incentives that currently reward speed and procedures over prevention and listening must be reset so that continuity of care, dignity, and patient voice carry weight equal to technology and intervention. Regulators must be funded by the public they serve, not the industries they police, and the revolving door of employment between the two must be closed. Education should once again become a public good rather than a commercial pipeline, with continuing medical training freed from corporate sponsorship and redirected toward independent, evidence-driven instruction.
It is also essential to acknowledge that money itself is not the enemy. Those who dedicate their lives to healing cannot be expected to do so in destitution. Fair compensation is necessary, and research requires resources. What corrodes the system is when financial reward becomes detached from service and reattached to lobbying victories, patent games, and billing codes. Profit must remain a tool that sustains healers and advances science, not the sole determinant of what is considered legitimate care.
Today most of American healthcare runs on a fee-for-service model. Every test, visit, or procedure generates a billable code. This creates pressure to increase volume rather than value, rewarding throughput over thoughtfulness. Doctors are forced to squeeze more patients into shorter visits, while preventive conversations, which take time but generate little revenue, are devalued. Alternatives exist. Salary-based compensation, used by systems such as the Mayo Clinic, provides physicians with income stability and removes incentives to maximize billing volume, allowing more time for patient relationships. Global budgets, tested in Maryland’s hospitals, gave institutions a fixed annual budget. The model reduced avoidable admissions and readmissions by pushing hospitals to prevent costly hospitalizations instead of chasing reimbursement for every procedure. Carefully designed value-based payments can shift focus toward outcomes, rewarding improvements in chronic disease management, reductions in unnecessary hospital use, and patient satisfaction. Each model has trade-offs, but all demonstrate paths away from the distortion of fee-for-service. They also show that physicians can maintain financial security while aligning their work with what society most needs: healthier people and fewer preventable deaths.
Access to medicines that sustain life must also be protected. Insulin, inhalers, and other essential treatments should be capped in cost, and anti-evergreening rules must be enforced so that decades-old drugs cannot be shielded from generic competition by minor patent modifications. Hospitals and insurers must be held accountable for practices that reduce patients to billing codes, and payment systems must be redesigned to value prevention and human dignity as much as procedures.
If these changes are pursued seriously, progress can no longer be measured in corporate returns. It will be measured in lives saved, in preventable deaths avoided, and in patients who walk into a clinic knowing they will be heard. Only when dignity is restored at the center of care can reform be considered real.
Food for thought:
What would change if the true measure of legitimacy in medicine was not profit or patents, but the ability to heal?
Next week we continue connecting the dots with Big Pharma.
