Guest Editorial: A note on the notion of commercialism.

The essays in this Special Section are about the ethics of Commercialism in Medicine. They are written, for the most part, by bioethicists, with the support of several prominent physicians and a health policy lawyer. This journal is, of course, devoted to ethics. Thus, our intent is to subject the question of commercialism in medicine to ethical scrutiny. Much has been written about commercialism in healthcare but very little about the ethics of commercialism in healthcare. One of our authors, Dr. Jerome Kassirer, has encouraged a national dialogue about these issues. We hope to start that dialogue in the bioethical community and, through that community, into the nation. This opening essay is a prefatory note that states the theme of the Section, attempts some definition of the terms “commerce” and “commercialism,” and reviews the principal questions with which our authors deal. The Section proper opens with two essays written from the viewpoint of two leading participants and observers of medicine in modern America, both former editors of the New England Journal of Medicine. First, Dr. Arnold S. Relman states the theme of our Section, the problem of a medicine that has become enmeshed in commercialism. In the next essay, Dr. Jerome Kassirer, author of On the Take: How Medicine’s Complicity with Big Business Can Endanger Your Health, presents a picture of commercialism in contemporary medicine.1 Then Professor Marc A. Rodwin explains how recent health policy and health law have encouraged commercialism. There follow six essays written by bioethicists; two of whom are philosophers and four are practicing physicians. The bioethicists’ essays were written after two 2-day meetings at the Program in Medicine and Human Values of the California Pacific Medical Center in San Francisco. Professor Jacob Needleman, a philosopher who has written books about the practice of medicine and the meaning of money, sat through these discussions and offers some concluding philosophical reflections. It is important to note that when we say “philosophical reflections” we do not mean ethereal musings. Dr. Needleman intends his reflections to provide the essential questions of the national dialogue that Dr. Kassirer encourages. The dialogue should begin, as Socrates showed centuries ago, with an attempt to define the terms. “Commerce” is, in itself, a neutral term. We have a Department of Commerce, chambers of commerce, commercial paper, and laws about interstate commerce. Most words ending in “ism” have an air of