Winter 1998

Angell's Clout
by Anne Saita

It's likely Dr. Marcia Angell ('60) was just as petite and slender as a Madison College student in the '50s as she is now that she is in her 50s. But don't be deceived: As executive editor of the New England Journal of Medicine, author, medical and media spokeswoman and Fulbright Scholar, she carries considerable weight.

Time magazine confirmed her prominence last April when it recognized Angell as one of the 25 most influential people in the United States.

At the prestigious journal, Angell has a hand in just about everything we know about our health, from diseases and disorders to the dangers of secondhand cigarette smoke and yo-yo dieting. Physicians worldwide review the journal's carefully scrutinized studies and editorials to help determine treatments. The rest of us regularly rethink our diets and daily routines when the mainstream press provides the layman's version of these same articles. Among its 230,000 subscribers are the nation's major stock brokerage firms, whose clients can win or lose fortunes based on what it reports.

There are plenty of other scientific and health-related publications out there, but none carries as much clout as the one put out by the Massachusetts Medical Society. The person ultimately responsible for its content is Angell, a pathologist who oversees the magazine's operations and 20-member staff. She is second only to the editor-in-chief, Dr. Jerome Kassirer.

"There are no typical days, and that's one of the wonderful things about this job," she says. "The journal comes out 52 times a year - year in, year out. Christmas, Fourth of July ... we have to put out an issue. So there is an extremely rapid pace, a tremendous volume, and the necessity to be flexible and respond to emergencies and stick 11 fingers in the 12 holes in the dike. I like that pace. And I like the tremendous variation of life here."

Angell reads every manuscript that makes it into the Boston-based journal, which averages 18 articles an issue. A majority are hard-core, with titles like "The Efficacy of Terazosin, Finasteride or Both in Benign Prostatic Hyperplasia." The rest is generally easier on the eyes, dealing with "softer" subjects like health policy, economic issues, medical ethics and health-care reform.

Occasionally, Angell's name moves beyond the masthead to a byline, in the journal and elsewhere. A favorite topic is physician-assisted suicide, which for years she has passionately supported, particularly after her 81-year-old father, suffering from prostate cancer, killed himself.

"Long before my father's death, I believed that physician-assisted suicide ought to be permissible under some circumstances, but his death strengthened my conviction that it is simply a part of good medical care - something to be done reluctantly and sadly, as a last resort, but done nonetheless," she concluded in a Jan. 2, 1997, New England Journal of Medicine editorial.

Lately, her literary attention has been devoted to junk science, which she denounces in her 1996 book Science on Trial: The Clash of Medical Evidence and the Law in the Breast Implant Case. In it, she critically examines the federal government's ban against silicone breast implants and subsequent lawsuits and large settlements before scientific study on their safety was completed.

"I decided to write about the breast-implant controversy because I had been impressed over the last three years ... with the increasing disparity between what's happening in the courtroom and what's happening in the courtroom of public opinion and what was happening in science. They were growing farther and farther apart."

The success of Science on Trial has led to more requests to talk before a broad variety of audiences. Major newspapers, magazines and television networks frequently call for her opinion.

Yet, when she heard about the Time recognition, no one was more surprised than the subject herself. "I was astonished," Angell says from her sixth-floor office at Harvard University's Francis A. Countway Library of Medicine. "I knew that they were doing a story on me because everywhere I went for about a month, people kept saying, 'Oh, Time magazine's phoned me about you.' I wasn't sure what the story was for. ... I had no idea I was going to be named one of their 25 most influential people."

The Time distinction and other accolades and accomplishments, she'll tell you, have come mostly from "happy accidents" on a career path rife with roadblocks.

"I don't think many women in my position would have mapped that out," she says of her circuitous trip to the top. "It's not the kind of position you can get to with a plan. But I think that my life was even more disorganized than most, and it was a matter of seizing the moments when they came."

Her story began 58 years ago when she was born in Knoxville, Tenn., and six years later moved to Arlington, Va. The family moved again during Angell's junior year to Buffalo, N.Y., and the miserable teen pined for her former life in Virginia.

She came to Madison College because of a boyfriend and ended up the faculty's darling, double majoring in chemistry and math and minoring in biology.

"My experience at Madison was terrific in many ways. The fact that the math department and the chemistry department and the biology department - and, indeed, the whole school - were so small, you got a level of attention that you could never get at a bigger institution ... ."

To illustrate, Angell recounts the time she uncharacteristically bombed a biology test because she'd become obsessed with a take-home math exam. The professors from both departments convened to discuss the anomaly and then offered her a chance to retake the test.

She equally excelled in English and history. "In many ways, I loved writing and history more than science and math."

In 1960 she went to Germany to study microbiology at Goethe University on a Fulbright Scholarship. After returning, Angell reunited with her Madison roommate, 1959 valedictorian Bettye Lynn Melton Reynolds, who was living in the Boston area, and enrolled in medical school at Boston University.

Gaining entrance was tough for women in those days; gaining acceptance was even tougher. "When I went to medical school in 1963, there was tremendous bias against women in medicine. The very first day at school a classmate - a male classmate - came up to me and said, 'Why don't you become a nurse?' And I said, 'I don't want to be a nurse. If I wanted to be a nurse, I would have been a nurse.' And he said, 'Well, I hate to see a woman jumping into a man's pants.'"

What really threw her were the faculty members, like the teacher who addressed everyone, including Angell, in a six-student seminar as "gentlemen."

"Even scientifically, there was a lot of what can only be described as old wives' tales being taught in medical school as though they were true," Angell says. "I was taught by a psychiatrist at Boston University School of Medicine that morning sickness was a woman's attempt to reject her feminine role."

A similar theory was furnished for dysmenorrhea, the medical term for difficult or painful menstrual cycles. "And I was taught this by people who, if they wanted to know about dysmenorrhea, could have asked me."

Today, Angell is committed to the scientific method of study, which requires theories to be proven through empirical data. Angell holds authors to exceptionally strict standards during the peer review process, and some say it's a major reason people put more credence in New England Journal of Medicine studies.

While she was an intern, Angell married physicist Michael Goitein and gave birth to her first daughter, Lara, during her residency in 1969. "There was no such thing as maternity leave or hospital-based day care," she said in a 1989 article for BU's Centerscope magazine. "It was understood that you would either have your baby on the weekend and come back to work on Monday, or you would stop working altogether and feel a little ashamed of yourself. I did the latter."

Then Angell was invited to write a textbook with Dr. Stanley Robbins. Basic Pathology was published in 1971, shortly after daughter Liza was born. The book was revised in 1976 and 1981 and is considered a med-school must.

Angell steered her career path around the lives of daughters Liza (left), a Yale law student, and Lara, a Harvard medical student. "For as long as I can remember, every evening my mom sits propped up in bed with manuscripts around her, reading and eating popcorn," Lara says.

A few years later, Angell resumed her medical career and, through the support of the pathology department chair at New England Deaconess Hospital in Boston, completed the program in two years.

During her residency, Angell was approached about working part time for the journal and soon found her calling. She received her certification in pathology, then joined the staff in 1979 as an assistant deputy editor. After two more promotions, she became the first female executive editor in 1988.

"She was obviously very busy throughout my childhood, writing a textbook in the early years, then doing her residency and working at the journal. But I never felt a lack," says Lara Goitein, even though her parents divorced. "I always had the impression we came first with her, which I think is incredible because she's achieved the kind of success in her career that most people only achieve when they put their career ahead of family."

Angell has attained a balance that has allowed her to raise both her children and national awareness. It's a life that, 40 years ago, Angell could not have imagined.

"If I had dreamed that I would be where I am today, I would have recused myself [because] of hubris," she says, laughing. "I feel very fortunate that in my professional life, and in some respects my personal life, I have exceeded anything I would have dreamed.

"I've been very lucky."

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