There is a particular kind of authority that comes only from having been inside something for fifty years — from having seen it at its best, trained its practitioners, published its science, and then watched it hollow itself out from within.
Dr. Peter Kowey has that authority. He holds the William Wickoff Smith Chair in Cardiovascular Research at the Lankenau Institute for Medical Research, is a professor of medicine and clinical pharmacology at Thomas Jefferson University, and spent years as chief of cardiovascular diseases at the Lankenau Heart Institute. He has published more than 450 scientific papers, trained hundreds of cardiology fellows, and served on FDA advisory panels. He has also, in the past several years, become someone who cannot stay quiet.
His new book, Failure to Treat: How a Broken Healthcare System Puts Patients and Providers at Risk, is built from twenty short stories — each a fusion of real composite cases, each naming a different fracture in American medicine. Fragmented care with no coordinating physician. An electronic medical record redesigned to serve billing rather than patients. Defensive medicine that orders unnecessary tests because the malpractice system makes not ordering them dangerous. Private equity that purchases hospitals to strip and sell them. Primary care physicians asked to address four chronic conditions, review a medication list, conduct an exam, and dictate a note — in ten minutes.
The book was born from a charge. Kowey's mentor was Dr. Bernard Lown: Nobel Peace Prize laureate, inventor of the defibrillator, one of the most morally serious physicians of the twentieth century. When Lown himself became a patient near the end of his long life, he encountered fragmented care, indifferent nurses, and cavalier doctors. He lived to 99, but not easily. In the years before his death, he told Kowey: "I'm really relying on you to try to do something about this."
In this conversation, Kowey does not soften the diagnosis. The current administration, he says, has taken a broken system and made it exponentially worse: NIH funding running at half last year's levels, the CDC's expert panels cleared of independent scientists, vaccine skepticism in positions of authority, and cuts to Medicaid, Medicare, and veterans' healthcare that will take years to repair even if reversed tomorrow. He is blunt about what the fix requires: universal coverage, a salaried physician model, restored professional status for nurses, and loan relief tied to primary care service.
He also holds out something harder to sustain than outrage: genuine hope. The people who go into medicine still go into it to help. That instinct, he believes, will outlast the systems that are trying to exploit it.
The book is available on Amazon and wherever books are sold.
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In this episode:
Why fragmentation of care is the single most dangerous feature of modern American medicine
How the electronic medical record became an instrument of billing rather than care
Defensive medicine, malpractice reform, and the billions they cost
Private equity in healthcare and the creation of hospital deserts
The ten-minute primary care visit and why physicians are leaving the field
Direct-to-consumer drug advertising: the United States and New Zealand against the world
NIH, CDC, vaccines, and the public health erosion under the current administration
The case for universal healthcare — and what getting there actually requires
