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White Coat Notes

What US can teach Canada

Excerpts from the Globe's blog on the Boston-area medical community.

Discussions about healthcare often look north to the single-payer model in Canada. But the tables are turned, now that the Canadian Medical Association has recommended allowing private competition to enter its national healthcare system.

That way lies disaster, Dr. Arnold S. Relman argued last week on, the online partner of The Globe and Mail in Toronto.

"If Canada were so unwise as to allow privatization to grow in its health-care system, it would sooner or later experience all of the problems driving the US system toward collapse," wrote Relman, a Harvard emeritus professor and former editor of the New England Journal of Medicine. "When medical care and health insurance are allowed to become private businesses, costs go up and patients with little or no resources do not get the care they need. That is the lesson Canadians should learn from the United States."

Tufts Health Plan on top

Tufts Health Plan tops this year's Consumer Reports reader survey rating HMO plans, with Harvard Pilgrim Health Care and HMO Blue not far behind. Blue Cross Blue Shield of Massachusetts finished among the top PPO plans, according to the September issue.

The health plans were judged on how satisfied respondents were with the choice of doctors, care from doctors, access to doctors, primary-care doctors and billing. A perfect score of 100 means perfectly satisfied, 80 means very satisfied and 60 means fairly satisfied.

Drug review signs positive

The voices of independent scientists are more important than ever, according to a critic of drug-company influence on government regulation, and there are signs they are being heard more than before.

Writing in the current New England Journal of Medicine, Dr. Jerry Avorn of Brigham and Women's Hospital and Harvard Medical School notes that Congress has authorized for another five years a system in which pharmaceutical companies pay user fees to support the salaries of the Food and Drug Administration's internal drug-review staff. That makes unbiased experts on outside advisory committees critical to the drug evaluation process, he says. The FDA's more stringent stance on committee members' industry ties has worked, he writes, comparing the approval of Vioxx in 1999 to this year's rejection of Arcoxia. Renewed assertiveness by FDA's external advisers made the difference in reviews of the painkillers linked to cardiac risk, he wrote.

"Though the quiet voice of science may often be no match for powerful vested interests or ideology, some encouraging signs may be in the air," he wrote. "The same reauthorization bill, disappointing in so many respects, may tighten somewhat the conflict-of-interest rules for outside advisers."

Helping physician-scientists

Seven Boston physicians who spent a year or more away from medical school doing research have won grants to continue their dual roles as scientists and clinicians.

The Howard Hughes Medical Institute has given Early Career Awards of $375,000 each over five years to 20 doctors to make sure they have the time and financial support for research early in their careers, it said in a statement.

The winners are: Dr. Sarah Fortune, Harvard University School of Public Health; Dr. Aram Hezel, Massachusetts General Hospital; Dr. Farouc Jaffer, Massachusetts General Hospital; Dr. Eric Johannsen, Brigham and Women's Hospital; Dr. Sridhar Ramaswamy, Massachusetts General Hospital Cancer Center; Dr. Manish Sagar, Brigham and Women's Hospital; Dr. Sean Savitz, Beth Israel Deaconess Medical Center.