Through this point, my primary response to the draft was that it fell into two segments, imperfectly coordinated. In the first, the use of the medical information flow in the net by the pharmaceutical molecule merchants is the subject. They have the wealth to buy up the new media, as they bought up the old ones, leading to the television-advertising nightmare in the US, for example. In the second, the relative passivity of the physicians in using medical education to improve treatment of their own patients is described. The connection between the first and second, however, which has to do with the overall capture of delivery by pharma and the reduction of physicians to pill pushers on the clock, is not described.

The changing social structure and behavior of the health care system of the US, as we moved from small-businessmen-doctors and a rich but subservient pharma, to a managed care universe in which doctors are employees on the clock and pharma owns more than anyone else, are the implicit subject of part one. This brief part two deals with a profession differently organized and therefore differently affected by the changes we are considering.

So my overall response to the draft is that it tries to do too much in 1,000 words, and would do a far better job of less. Less would also be capable of trenchant and brief statement at the outset, involving the presentation of a single new idea to the reader, who could then follow its development through the line of the essay, which is not, as I have tried to show, very easy now.