Good and bad lessons from the United States
Authors: K. Abbasi
Journal: Journal of the Royal Society of Medicine (2006)

The JRSM's readership is mostly UK based, with our second largest readership hailing from the United States of America. Yet the difference in reader numbers between the UK and US is so large that this publication is some way from becoming a transatlantic journal, although when you read this issue you might be forgiven for gathering that impression.

The increasing influence of US healthcare and US healthcare organisations on the UK's health system are good reasons to occasionally dip this Journal's pages in the Atlantic.

For instance, both of this month's research papers are analyses from across the pond. First, Arch Mainous III and colleagues compare diabetes management in adults between England and the US, a highly topical issue since the English government is planning to offer opportunities in primary care provision to American companies, among others (p. 463).

Some early but contentious evidence has suggested that the UK's health systems, systems that offer universal access, might have much to learn from the US and its market-based system. Particularly since advocates and critics of the current reforms in the English health service love to talk of the ‘emerging healthcare market’—which is a good or an evil thing depending on your politics.

Mainous III and his fellows (none of whom, disappointingly, have Roman numerals after their names) judge that individuals in the universal access healthcare system have better management of diabetes, as measured by HbA1c and prescription of ACE inhibitors, than those who are uninsured in a market-based system. Indeed, the differences between the uninsured and the insured in the market-based system are also eye-catching.

The second paper, a comparison of reports of randomised controlled trials and systematic reviews in leading UK and US surgical journals, finds little difference across the Atlantic (p. 470). The point here is that the world of surgery has long been criticised for not conducting enough studies with a rigorous design, and an up-to-date evaluation of the published literature should give an indication of any improvement. Disappointingly, the UK and the US turn out to be as bad as each other, with randomised controlled trials and systematic reviews comprising only a small percentage of the publications in these leading journals.

Where the UK can certainly learn from the US, argues Donald Irvine, is in the way in which Troy Brennan has lead recertification for internists in the US. The specific lesson is for the Royal Colleges and specialist societies who Liam Donaldson, England's Chief Medical Officer, has handed the responsibility of delivering the recertification element of revalidation for their members (p. 430). This is one of many significant proposals presented by Donaldson in response to the Shipman inquiry.

Irvine gives the proposals a vote of confidence with some important caveats, particularly with regards to undergraduate education and the future role of the GMC. Irvine believes, some might think contentiously, that the council of the regulatory body should be ‘disbanded and its successor re-formed with members, medical and lay, who can give it a convincing fresh start.’ Do you agree? The Chief Medical Officer has asked for your views and so does this Journal—from either side of the ocean.