The Vancouver Sun
Tuesday 4 July 2000

U.S. HEALTH CARE 'INSANE' COMPARED TO CANADIAN HEALTH SYSTEM

        There's nothing wrong with medicare that more money won't
        fix, B.C. doctors told.

        By Pamela Fayerman, Sun Health Issues Reporter

VICTORIA -- Even with its problems, the Canadian health care system is
"increasingly making the American system look insane," the editor of the

prestigious New England Journal of Medicine says.
        Addressing about 200 doctors at the annual meeting of the B.C.
Medical Association, Dr. Marcia Angell said she has long been an
advocate of Canadian medical care.
        "The U.S. is the only advanced country that distributes medical
care
according to the ability to pay, not on the basis of need," she said.
        Angell joined the New England Journal of Medicine in 1979,
became
executive editor in 1988 and editor-in-chief last year. She is only days

away from retiring from the job, after which she plans to write a book
about complementary and alternative therapies.
        Angell said the problems she perceives in the Canadian system --

such as long waiting lists for urgent care -- seem more easily fixed
than
the U.S. system.
        "Your system is fine -- the problems are not ones which can't be

fixed; you just need more money in it," she said.
        Angell, who was trained as an internist and pathologist, focused

mainly on the emerging interest in medical news in her speech.
        She bemoaned the current state of affairs in the U.S. in which
health
research is becoming a subject of fascination and sensationalism and
the public is caught up in the frenzy of the buyer's market for medical
services. She said this is especially apparent where doctors compete
against each other for patients.
        To satisfy consumers' voracious appetite for health news, the
media
appears always happy to report on the latest clinical trials, even when
results are modest, she said. Such reporting offers the public only a
"nanosecond of explanation" and a potential for misinterpretation.
        The medical consumerism now prevalent in society means it is
more
important than ever for medical journals to ignore the "babble of health

chatter . . . to filter out the inaccurate from the accurate, the
reliable
from
the unreliable."
        Angell said scientific researchers have a duty to be honest and
ethical, "to follow the evidence wherever it leads without concern to
the
impact of the results."
        She said researchers are too biased to evaluate the importance
of
their own work. That job must be left to a rigorous peer review process
that culminates in published studies in journals that aren't "playing to
the
media and the public."
        While the recent announcement about human genome research is
"terribly exiting," Angell said she believes the coverage of the story
has
contained a lot of hyperbole.
        Though she doesn't doubt the accuracy of the work, "the payoff
may
not occur for years -- the science is still very imprecise at this
time."