Bmj Usa: Education And Debate

The emergence of “boutique medicine”

BMJ 2003; 327 doi: (Published 19 November 2003) Cite this as: BMJ 2003;327:E129
  1. Uwe E Reinhardt, professor of economics and public affairs (
  1. Princeton University, Princeton, NJ

    From BMJ USA 2002;August:468

    The January 26, 2002 issue of the BMJ featured a news report by a Florida doctor, Fred Charatan, raising concerns about the emergence in the US of “boutique medicine,” ie, practices that offer premium service for patients willing to pay large fees ( This generated a letter to the editor of the BMJ by Uwe Reinhardt, a professor of economics at Princeton University, which in turn set off an exchange of Rapid Responses (see Among the entries in that exchange was the following (abridged)—EDITOR

    Physicians pursue a variety of objectives, among which income quite legitimately ranks high. In the economist's book, there is nothing wrong with the pursuit of income. Furthermore, economists believe that persons who have accumulated the human capital that physicians have ought to earn commensurately high incomes.

    The problem is that an informal etiquette …

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