Marker, Robin Cook's new book

Robin Cook’s new book, Marker, should be a revelation for anyone contemplating health care, weather a planner or a consumer. We have, in my lifetime, deteriorated from the most advanced health care nation to a dangerously extortive and greedy delivery system wherein the patient needs come in second to the considerations of administrators, insurance companies, HMOs and even the government with a political agenda. Furthermore, advances in genetics stager the imagination in, not only the understanding of the antecedents of disease, but also the potential to prevent illness on a scale not yet even partially realized.

In the Marker, Cook takes us through the deeply emotional reality of genetic testing and the fore knowledge of disease. In the process he shows us the disturbingly criminal extreme to which managed care can take us and he paints, from a physician’s viewpoint an exciting “who dun it” of a dangerous and difficult diagnostic challenge. While this is entertainment at its best, it is a story with a message, two messages, maybe a third reflecting the foolishness of expecting centralized big business to, responsibly, answer the need for a community based critical infrastructure.

From my perspective, the Federal Government runs the same challenge more on the side of waste and inefficiency, which prompts the whole idea of privatization in the first place. I agree with Dr. Cook’s conclusions in the author’s notes but would differ in suggesting that the solution lies with the competitive diversity of State run delivery systems, modulated by the medical schools and supported by university research, statistics and IT capacity. Medicine is a science, and, as such, the research, teaching and technology continually change, as do therapeutic regimens. People and problems differ by region. Solutions not only differ by region, but by scientific exploration and academic competitiveness. The changes implicit in genetic research foreshadow a change that neither centralized managed care, nor governments can understand much less direct. At the end of the book, the patient transfers to the University Hospital with the implication that it remains the one place above reproach, and indeed, such is true in most cities today.