COMMENTARY

Obituary for John M. Eisenberg, America's Top Doc

Introduction

John M. Eisenberg, MD, MBA, died at his home in Potomac, Maryland, at the young age of 55 on March 10, 2002, following a 14-month battle against a high-grade malignant glioma. A native of Atlanta, Georgia, John spent his boyhood in Memphis, Tennessee, and took his undergraduate degree at Princeton in 1968. His medical degree was from Washington University and his internal medicine training, as well as his MBA, were received at the University of Pennsylvania. He leaves as family, his wife, 2 sons, his mother, and 3 brothers.

Some time after "Chick" Koop left the Surgeon Generalcy in 1989, what with the recurring lapses in filling the Surgeon General position, the downgrading of the Assistant Secretary of Health position, and the well-chronicled continuing problems at the American Medical Association (AMA), the United States really did not have anyone who could rightfully be called "America's Top Doc." Around 1999, I began to refer to John Eisenberg in speeches and conversation as my nominee for Top Doc. No one ever expressed disagreement; many told me they agreed.

Ask anyone who had contact with John what they thought about him, and you get a positive reaction, even a smiling, glowing description and, as likely as not, an anecdote about some special relationship they felt with him. He touched people. Why? Was it his obvious intelligence? Yes. His judgment and perspective? Yes. His high-quality education at good institutions? Yes. His cogent method of representing a complicated and difficult issue in a balanced way? Yes. His warm, honest, and direct manner, even when a bureaucrat, that disarmed one and evoked trust? Yes. His strong academic positions at Penn and later at Georgetown? Yes. His leadership in the emerging critically important and timely fields of general internal medicine and health services research? Yes. His influential advisory role for various government committees and commissions since 1986, long before full-time government service? Yes. All of these things and more.

Let me share some personal anecdotes. I first met John on a platform at a meeting on health insurance economics in 1980 in Chicago. We were both speakers and sat side by side. I liked his talk on how to change physician behavior so much that I solicited it for the Toward Optimal Laboratory Use column in JAMA, well before I became the JAMA editor. He (with Sankey V. Williams) wrote the speech up and JAMA published it in late 1981 as "Cost Containment and Changing Physicians' Practice Behavior. Can the Fox Learn to Guard the Chicken Coop?".[1] This paper remains a classic in a field that unfortunately has developed little since that article.

Of course, John was one of our best long-term JAMA reviewers. Then, on November 19, 1997, JAMA published a theme issue on quality of care. After the press conference invitation was sent out, I got a call from the White House inviting me to bring a few other appropriate physicians to a meeting with Vice President Al Gore and various high-level staff on the morning of November 18 prior to the planned AMA Washington press event featuring the JAMA articles on quality. I invited David Blumenthal and Arnold Epstein from Harvard and Tom Reardon of the AMA. The deal was that Mr. Gore would call attention to the JAMA theme issue in his remarks to the media if I would call media attention later that morning to the interest of the White House in quality of care. This all came off as planned. At the White House meeting, John Eisenberg sat right across the table from us adjacent to Vice President Gore. This was during one of those Washington gaps when there was neither a Surgeon General nor an Assistant Secretary of Health. John Eisenberg was heading up the besieged Agency for Health Care Policy and Research (later AHRQ) and apparently also acting informally as Surgeon General and Assistant Secretary of Health all at the same time.

Fast forward: January 12, 2001. Aventura, Florida. The Commonwealth Fund, under Karen Davis' leadership, sponsored a 2-day intensive workshop for 27 members of the US Congress and Senate on issues of health policy, using mostly faculty from the Harvard JFK School of Government and the School of Public Health, as well as government health leaders. Of course, John Eisenberg was there in a leading role. When arriving at an evening reception on the first day of work, many of us were shocked to learn that John had suffered an incapacitating seizure while playing tennis following the afternoon meetings. We physicians in the group recognized that it was a very bad sign for an adult to experience a first seizure and were profoundly worried. He was hospitalized and later moved to Hopkins, where I understand that the anatomic diagnosis of a high-grade glioma was made, and surgery plus radiation begun.

Although characteristically still working part-time during radiation therapy, John was not able to be present at the AHRQ when a Medscape colleague and I visited there on February 27, 2001, to discuss a Medscape-AHRQ collaboration, an ominous sign. Yet, at the annual San Diego meeting of his beloved Society of General Internal Medicine, he gave an excellent speech with no impairment to hundreds of deeply respectful colleagues and received an emotional, standing ovation. His handshake afterward was firm and his hands warm and dry. That was May 3, 2001.

And here we are again with Washington, DC in 2002 experiencing the biggest political/bureaucratic medical leadership vacuum that I can recall. Just John's kind of challenge. We have no Surgeon General (or nominee, despite the 1-year notice of David Satcher's resignation), and no chiefs of the US Food and Drug Administration or the National Institutes of Health (one person has been reported as close to nomination) after long vacancies, and soon even the Centers for Disease Control and Prevention head will be departing. But this time the country has no John Eisenberg to fill in, to work in front and behind the scenes on behalf of the public's health, for quality of care, for patient safety, for the American people and the health of the medical profession, to do the right thing, no matter what. Very sad.

We thank you for your life of service, and we miss you, John, America's Top Doc.

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