Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor
To the Editor: Dr Starfield1
fails to mention the prevalence of obesity in the US population. I suspect
that this is significantly higher than that of the comparison countries and
might well account for the differences in health care indices that she cites.
I must also comment on the statistics on iatrogenic morbidity and mortality.
In virtually all of the countries mentioned, a specialty board (such as the
Royal College of Surgeons) controls who is allowed to practice a specialty.
Specialists generally cannot practice unless they complete a residency approved
by the College and pass a certification examination given by the College.
In the United States, specialists are allowed to practice when "board-eligible"
and never need to take a certifying examination. Is it surprising, then, that
the United States has a high level of poor outcomes?
White BL. Deficiencies in US Medical Care. JAMA. 2000;284(17):2184-2185. doi:10.1001/jama.284.17.2184