Summer 2017

Unanticipated Outcomes

You never know just where a career in medicine will take you. 

By Courtney Hollands

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Photo: Anna Miller

When Dr. Jerome Kassirer left the editorship of the New England Journal of Medicine in 1999, questions about his premature departure lingered. For years, he wondered whether the boxes of letters and memos he took with him might provide answers. “I finally decided to look through them to see what I could find,” said the Tufts University School of Medicine distinguished professor. The result is Kassirer’s new book, Unanticipated Outcomes: A Medical Memoir, which traces his career from medical school through his contentious ousting from the Journal—following disagreements with the Massachusetts Medical Society—and beyond.

Tufts Medicine: You write that many would consider your career path “the American Dream.” Tell us more.

Dr. Jerome Kassirer: I never expected to be an academic physician, and yet I ended up at Tufts on the staff and on thefaculty. And then I became vice chair of the department of medicine, though I never could have imagined earlier that I’d even end up as an academic. Then when I got invited to be involved with the American College of Physicians and the American Board of Internal Medicine, I realized that I could function effectively in national organizations. Finally, the work I did in acid-base metabolism and clinical decision-making ultimately led to my nomination for the editorship of the New England Journal. Never in my wildest dreams had I ever imagined that I’d become the editor.

Hardly any of this trajectory was planned. It all happened along the way as opportunities came along, which explains the book’s title—few of my career outcomes were anticipated.

TM: What did you learn from your experience at the Journal?

JK: Well, it certainly humbled me when I was fired. Aside from that, I learned—to my satisfaction—that there are people who really care about the integrity of medicine and the quality of the NEJM. When I took over the job, I inherited a group of outstanding clinician-investigators who not only helped me with the task of editing the journal but supported the changes I made in the publication and my differences with management. Moreover, I learned that the public also valued the integrity of science.

TM: You’ve often decried financial conflicts of interest in medicine. Is this still a problem?

JK: I think we made some progress in dealing with financial conflict of interest. Many institutions have policies now that had never existed. Both the Institute of Medicine and the Association of American Medical Colleges issued analyses about the conflict-of-interest problem, and Congress passed the [Physicians Payment] Sunshine Act. There has been modest progress.

But, at the same time, financial conflict of interest is still a very serious problem—made even more serious now that we have an administration in Washington where flagrant conflict of interest is the rule rather than the exception. I think this unprofessional attitude has spread across the country and infected medicine even more.

TM: What will you remember most from a lifetime of medicine?

JK: I greatly enjoyed taking care of the sick, doing clinical research, getting involved in major organizations, writing, editing and working with some of the great masters of American medicine. I am extraordinarily grateful to be part of this enterprise. (The book can be purchased at


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In Out in the Rural, historian Thomas J. Ward Jr. relates the story of the country’s first rural community health center: The Tufts-Delta Health Center, established by School of Medicine faculty member Dr. H. Jack Geiger and his team in Mound Bayou, Miss., in 1967. “The ultimate goal,” Geiger writes in the foreword, “was to establish pathways out of poverty into a better life.”

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