American Medicine God: Starting by Inheriting a Pharmaceutical Company and Selling Medicine

Chicago, Illinois.

The air in the conference room at the headquarters of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) was so heavy it felt like water could drip from it. For the administrators of more than 6000 hospitals across the United States, this organization is their "Supreme Court," or even their "God."

Because it holds the hospital's "book of life and death"—certification qualifications.

In the US healthcare system, losing JCAHO accreditation means a hospital is ineligible for Medicare and Medicaid reimbursement. This can lead to funding shortages, bankruptcy, and closure.

In the first conference room, members of the JCAHO standards-setting committee sat on one side of a long mahogany conference table. Most of them were senior medical experts with gray hair, wearing white coats or conservative suits, holding the newly printed "Draft of the 1994 Hospital Accreditation Standards".

On the other side of the table sat a representative of the "National Brain Health Action Alliance".

The leader was Saul Goodman.

But today he wasn't wearing his signature gaudy suit; instead, he was dressed in a dark blue Brooks Brothers suit, wearing gold-rimmed glasses, and his hair was neatly combed. At that moment, he didn't look like a gangster lawyer, but rather like a serious law professor or a philanthropist concerned with public welfare.

Sitting next to him were several anxious, even somewhat neurotic, "patient rights representatives." They looked perfectly normal, without wheelchairs or oxygen tubes, but the fear and unease in their eyes were more heartbreaking than any physical injury.

"Gentlemen," Saul stood up, his tone somber and solemn, as if reading a eulogy, "for the past half-century, our medical community has been committing an unforgivable oversight in this room."

He paused for a moment, his gaze sweeping over each committee member present, his eyes sharp as knives.

"We focus on blood pressure, heart rate, and body temperature. But we neglect the most important and vulnerable organ in the human body—the brain. We tell patients, 'You're just tired,' 'You're just stressed.' But is that really normal?"

Saul took a chart out of his briefcase and showed it to everyone.

That wasn't an ordinary chart, but a simplified version of the Hamilton Anxiety Scale (HAM-A), redesigned into a brightly colored and easy-to-understand self-assessment card for stress.

From green representing "calm," to yellow representing "tension," and finally to red representing "collapse."

“Look at this chart,” Saul pointed to the red area. “This is the mental state of a 35-year-old Wall Street trader before his sudden death. He told his doctor he had chest tightness, insomnia, and tremors, but the doctor only prescribed him vitamins and told him to go on vacation. Three days later, he jumped from the 40th floor.”

Thor's voice was deep and powerful, carrying a sense of oppression.

"What is this? This is a misdiagnosis! If our hospitals don't even have the most basic ability to recognize a patient's 'mental breakdown,' what right do we have to talk about saving lives? This isn't medicine; this is disregard for life!"

A hush fell over the meeting room. The committee members exchanged glances, their faces showing complex emotions. Saul's words struck at a blind spot in modern medicine—the long-standing neglect of mental health.

"Mr. Goodman," an elderly man sitting at the end of the long table took off his glasses. He was Dr. Robert Calloway, the former president of Massachusetts General Hospital. He was the toughest member of the committee and a staunch defender of old-school medicine.

"Your story is unfortunate. But in medicine, mental health assessments are extremely complex," Dr. Callaway said, his voice hoarse but firm.

He pointed to the colorful card, a hint of disdain flashing in his eyes.

"You want us to turn this...this thing that's like a magazine-style psychological test, into a medical standard?"

“This isn’t a psychological test, Doctor,” Saul retorted immediately. “These are ‘invisible vital signs.’ Just like body temperature, pulse, breathing, and blood pressure, ‘mental stress levels’ must be quantified, recorded, and intervened upon.”

"This is utterly absurd!" Dr. Callaway finally snapped, slamming his fist on the table. "Body temperature is objective; the mercury doesn't lie. Blood pressure is objective; the stethoscope doesn't deceive. But anxiety? Stress? That's subjective! It depends entirely on how the patient feels! If a patient claims their stress levels are off the charts to avoid work, what am I, as their doctor, supposed to do? Prescribe medication?"

"What if he really is on the verge of a breakdown?" Saul retorted, pressing further. "Do you have mind-reading abilities? Can you see his neurotransmitters depleting? How do you know he's lying?"

"I have thirty years of clinical experience!" Calaway roared. "I know what illness is and what's just whining! If you force this standard on us and link mental health scores to hospital performance, you're forcing doctors to abuse drugs! You're turning doctors into drug-dispensing machines!"

The old hospital director's voice echoed in the conference room. As a traditional guardian of healthcare, he instinctively rejected this approach of "fast-foodizing" and "quantifying" mental health. He sensed the danger behind these flowery words—the erosion of professionalism by capital.

The other committee members began to whisper among themselves; the winds seemed to be shifting. Callaway's prestige remained.

Saul Goodman remained calm. He smiled slightly and pulled out a thick document from the bottom of the folder.

"Dr. Callaway, you mentioned 'clinical experience.' So let's talk about modern management, or more precisely—legal responsibility."

He pushed the document over, and it slid down to Callaway.

"What is this?"

"This is the latest big data analysis of medical malpractice cases," Saul said casually. "The data shows that in the past five years, lawsuits stemming from 'neglect of mental health leading to suicide or injury' have increased by 400%. Juries are often sympathetic to the families of the deceased who have 'no other recourse,' especially when the defendants are large, indifferent hospitals. Every time a hospital loses, it has to pay millions of dollars in damages."

Saul walked behind Dr. Callaway's chair, leaned down, and spoke in a gentle, seductive tone, like a devil whispering in someone's ear:

"Doctor, we are not pressuring doctors; we are protecting them. Think about it: if JCAHO adopts our recommendations and makes 'psychological stress screening' a mandatory admission procedure, establishing a standard process, then in the event of a tragedy, the doctor can say: 'I fully complied with JCAHO's standards and conducted the screening and intervention.' That's the best absolution."

This is the real trump card.

Saul provided these bureaucrats with a perfect stepping stone, an institutionalized safe haven.

"In this day and age, if it's not documented, it didn't happen," Saul said, straightening up to the committee members. "We quantify anxiety to make healthcare traceable, assessable, and justifiable. This is a victory for 'holistic medicine' and a victory for 'risk management'."

Dr. Callaway looked at the documents on the table, then at his colleagues around him, who, though silent, had wavering eyes. He knew that the situation was hopeless.

In a society rife with lawsuits, no one can resist the temptation of "exemption from liability." Hospital administrators are more concerned with financial statements and legal risks than with scientific truth.

"...We need to rest for ten minutes." Dr. Callaway slumped back into his chair, looking as if he had aged ten years in an instant. "Then we'll vote."

half a month later.

JCAHO officially released the "1994 Patient Mental Health Assessment Standards". The core provisions stipulate:

1. "Mental stress level" has been established as the "fifth vital sign" that must be monitored (after body temperature, pulse, respiration and blood pressure).

2. All medical institutions must conduct mental health screenings on every admitted patient (regardless of the disease).

3. Patients have the right to receive "effective mental stress management".

4. Screening rates will directly affect a hospital's accreditation rating.

Water Pharmaceuticals headquarters, New Jersey.

Victor Corleone stood in front of the huge floor-to-ceiling window, looking down at the production line below.

Behind him was a wall of monitors displaying procurement data from major hospitals across the United States. Since the new standards were introduced, the red line representing "Nirvana" sales had never fallen, like a venomous snake raising its head.

"What a masterpiece." Saul walked over with two glasses of whiskey. "You should have seen the look on that stubborn old man Callaway's face at the end. He was reluctant, but he had to admit that we were helping the hospital avoid risks. He thought he was doing what was best for the doctors, but in reality, he signed a devil's contract."

"He's a good doctor," Victor said calmly, taking his glass. "But he doesn't understand management. In a large-scale healthcare system, 'experience' is the most unstable variable; 'standards' are the eternal foundation."

Victor walked to his desk and picked up a brightly colored "Psychological Stress Self-Assessment Card" sticker that had just been printed.

On it, the red "collapse" area is gaping open, as if screaming silently.

"From today onwards, this sign will be posted in every hospital, in every ward, and on every bed in every part of the country." Victor looked at the red area, his eyes deep. "Everyone who walks into a hospital will be asked the same question: 'Do you feel anxious?'"

"What if they say they're not anxious?" Saul asked.

"Then ask a second time. Until they realize that in this high-pressure modern society, 'anxiety' is the norm, and 'denying anxiety' is a morbid form of escapism." Victor sneered. "What we're selling isn't medicine, but the concept of 'brain health.' Once people accept this premise, the demand will be unleashed like a flood."

"And we," Victor raised his glass to the map covered in red, "are the ones who built the ark. When the spiritual torrent comes, only our ticket (Nirvana) can save them."

"Respect the fifth vital sign."

"To...the standardized future." Thor clinked glasses and drank it all in one gulp.

In bustling Manhattan, New York, and in quiet Midwestern towns, countless doctors are picking up their pens and checking the box for "moderate anxiety" on medical records.

For compliance. For rating. For avoiding prosecution.

The gears of the system began to turn, the enormous commercial machine roared, and the fates of countless people were swept into it.