Silent Treatment by Michael Palmer, Bantam Books, New York, 1995. Soft Cover 1996, 447 pages.

Review by Del Meyer, MD

Michael Palmer MD, an ER physician is at it again. This time he mixes some timely lessons in medical economics into his hair raising tale of murder and intrigue, exploring the insidious control of primary care by a for-profit HMO, and the privacy invasion activities of a secret alliance of large insurance companies who will go to any lengths to control costs.

Palmerís protagonist, Harry Corbett, a decorated Vietnam vet, is a family practitioner on staff at the primary contract hospital for Manhattan Health Cooperative, a rapidly expanding, aggressive FP-HMO. Two weeks before his 50th birthday he is watching his life unravel before his very eyes. His wife, who is becoming ever more cool and distant, is about to be hospitalized for repair of a cerebral aneurysm, his hospital privileges are being carved up piece by piece and doled out to specialists and sub-specialists, and he is starting to experience chest pain during his daily jog.

What follows is a first rate medical thriller that could only have been written by a practicing physician. The cast of characters includes a Soviet born doctor who is the best in the world at his chosen specialty - to keep torture subjects alive, awake and responsive; a popular, energetic HMO vice president of marketing and development; an influential, temperamental chief surgeon who likes to get even; a beautiful but unhappy ex-broadcast journalist who is hoping to break back into the big time with her latest investigative report on high priced prostitution; a perceptive young artist suffering from DTís and a skull fracture after a drunken fall down the stairs at her apartment; an out of work, recovering addict, unlicensed private detective with an old score to settle; and a secret society of insurance executives called the Round Table, who meet at the Camelot Hotel and know one another only by code names such as Lancelot and Galahad.

Plots and subplots branch and merge as the author weaves a realistic, terrifyingly convincing tale of seemingly routine medical and surgical practices in which the instruments are no longer under the direct control of physicians, but are actually held in the invisible hands of insurance company executives whose mission is to make money, not save lives.

Palmer reminds us that we must forever be on our guard, for the power to heal is very close to the license to kill.