Marcia Angell

Losing Weight — An Ill-Fated New Year's Resolution

Today, at the start of the new year, millions of Americans will resolve to lose weight, but by tomorrow, or next week, or maybe next month, most of them will have given up trying. Few will have los...

Industry-Sponsored Clinical Research: A Broken System

controversial character rather quickly. The faculty moves on—and this should encourage other AMCs to appoint their own task forces to design and implement change. As change becomes embedded in medical centers, it will be vital to analyze outcomes both qualitatively and quantitatively. There are many important questions to be answered: Do attitudes and practices change over time? Do house staff and medical students experience the change in terms of an intensified commitment to professionalism? Do disclosure requirements affect appointments to formulary committees or teaching assignments? As visits from pharmaceutical representatives decline, do physicians’ prescriptions for generics increase? What effect on research funding might occur? Does the pharmaceutical industry devise new strategies that undercut the policies, and if so, how do the AMCs respond? Last, but certainly not least, will AMCs make sufficient progress to obviate the need for government intervention?

The Pharmaceutical Industry — To Whom is It Accountable?

The pharmaceutical industry is under mounting scrutiny because of rapidly increasing expenditures for drugs in the United States. Drug expenditures are now the fastest-growing component of health c...

Excess in the pharmaceutical industry

The main point about excess in the pharmaceutical industry is how much there is of it. Here I can touch on only a few specifics about this altogether over-the-top business. ![Figure][1] Figure. Photo by: Earthlore Although the pharmaceutical industry claims to be a high-risk business,

Quality and the Medical Marketplace — Following Elephants

Suddenly, “quality” has become the watchword among those who care about the American health care system, and attempts to measure it are giving rise to a whole new industry. Just three short years a...

Clinical research--what should the public believe?

Americans have become increasingly avid for news of clinical research that they feel will improve their health or extend their lives. This is particularly true of research about diet or lifestyle. ...

The Case of Helga Wanglie: A New Kind of Right to Die Case

Helga Wanglie, an 86-year-old Minneapolis woman, died of sepsis on July 4 after being in a persistent vegetative state for over a year. She was the focus of an extremely important controversy over ...

On Authorship and Acknowledgments

LARGE clinical trials from multiple institutions now involve dozens and sometimes hundreds of people in their conception, design, implementation, analysis, and preparation of reports for publicatio...

Breast Implants — Protection or Paternalism?

IN this issue of the Journal, Dr. David A. Kessler, the commissioner of the Food and Drug Administration, presents his rationale for removing silicone-gel breast implants from the market.1 Each yea...

Setting the Record Straight in the Breast-Cancer Trials

In 1985 the Journal published a paper from the multicenter National Surgical Adjuvant Breast and Bowel Project (NSABP) showing that lumpectomy was as effective as mastectomy in the treatment of ear...