Code Blue

Book Title: Code Blue

Author: Mike Magee

Publication Information: New York, Atlantic Monthly Press, 2019, 422 pp., $27 hardcover, $18 paperback

Code Blue, by Mike Magee, MD, takes a unique approach to promoting a single-payor system by examining our current health care system through the lens of history. Dr Magee has practiced medicine as a urologist and participated in government agencies and the pharmaceutical industry, most notably as the physician face of Pfizer during the release of Viagra in the late 1990s. As a true insider, he has a unique perspective on the US medical system.

Magee introduces the term “medical industrial complex” to describe the elaborate and often profit-focused interplay between the insurance industry, pharmaceutical industry, political machinery at work for the American Medical Association and other agencies, pharmacy benefit managers, and academic institutions.

Code Blue weaves a brilliant tapestry of the history of the medical industrial complex. For example, he examines the pharmaceutical industry and its evolution from the primordial ooze of snake oil and cocaine to its present-day curative focus. He discusses the negative effects of direct-to-consumer advertising, unsavory marketing techniques like prescription profiling of clinicians, and publication bias, noting that “industry-funded studies were positive 85% of the time, compared to positive results in only 50% of the government-funded studies” (p 230). He examines major personalities that helped to create the system, including physician-turned-businessman and philanthropist Arthur Sackler as the “ultimate manipulative marketer” (p 150).

Cure versus care is also a major dichotomy addressed in the book. Magee points out that the sense that we, as a medical community, will fix or cure all ills often interferes with caring. Funding for the next wonder drug seems ever present from NIH sources, while funding for basic bench research and public health is minimal.

Since the idea of a single-payor system has become a politically charged issue, it is expected that the author would exhibit some political bias. While the author shares his political views throughout the book, these do not detract from the overall value of the book or the validity of the arguments made.

I suspect many of us in family medicine, along with clinicians in other specialties, have mixed feelings regarding a single-payor insurance system in the United States. It has become a hot topic lately as presidential democratic party primaries are underway at the time of this writing. Code Blue assaults our current medical system with a thorough examination of its history, allowing the relationships and events of the past to speak for themselves. It is a worthwhile read for anyone confronted with the challenges of clinical practice and searching for an answer to the questions, “How did we get here?” or “What do we do next?”