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Aarefa Johari: Why doctors need to speak out against female genital cutting in India

20 Jan, 17 | by BMJ

Female circumcision, known around the world as female genital mutilation or cutting (FGM or FGC), is recognised as a human rights violation by the World Health Organisation. It involves cutting or altering parts of the female genitalia for non-medical reasons. It is not much talked about in India and is known so far to be limited to a single community—the Dawoodi Bohra community. Although more severe types of FGC are practiced by several African communities, the kind that Bohras practice—cutting all or part of the clitoral hood—falls within WHO’s definition of Type 1 FGC. The practice is illegal in at least 40 countries, because there are no medical benefits to cutting any part of the female genitalia. In fact, even the mildest form of FGC can have harmful health consequences, including bleeding, swelling, painful urination, infection and reduced sexual sensitivity. more…

Abraar Karan: The success trap of academic medicine and the need for change

20 Jan, 17 | by BMJ

abraarThe career options available to physicians today are more diversified than they have ever been. Physicians are making their presence known in areas that are not fully clinical, including policy, management and leadership, the arts, communications, consulting, and more. Dual degrees have also been on the rise, with many more students pursuing the MD/MPH, MD/MPP, MD/MBA, and, less commonly, Master of Arts and JDs.

However, the criteria for being hired or promoted at the most prestigious medical centers in the US and UK, most of which are also prominent research institutes, primarily focus on academic output, such as papers, abstracts, and academic presentations. This has been noted as a problem for clinicians within these institutions, since they have to juggle providing the best clinical care with the demands of academic publishing. more…

Tessa Richards: Power to the people—via Paris

20 Jan, 17 | by BMJ

Tessa_richardsWho gets to define value in health systems? The notion that it should be the people who use their services, rather than those who provide them, is gaining momentum. At a meeting in Paris this week, convened by the Organization for Economic Co-operation and Development (OECD), revolutionary zeal was in the air as speakers urged health ministers to back the nascent science of “measuring what matters to patients,” and use the metrics to improve the performance of their systems.

The politicians listened. After a closed debate on the challenges facing health systems, led by Jeremy Hunt, secretary of state for health in England, ministers from the 35 OECD countries and nine other countries signed a lengthy statement on the “Next generation of health reforms.” It includes a pledge to support the systematic collection of validated and comparable cross country  indicators of service quality and value—as defined by patients—and use them as a yardstick to compare health systems performance. more…

Bernard Merkel: Should patients really be at the centre of healthcare?

20 Jan, 17 | by BMJ

bernard_merkelI attended the recent Organization for Economic Co-operation and Development (OECD) policy forum on the Future of Health, “People at the Centre,” with mixed feelings. [1] On the one hand, the conference had an exciting theme and would give me the opportunity to hear about some new ideas and international developments, as well as to catch up with old colleagues and friends. On the other, I noticed that the agenda was going to be dominated by presentations by various American health policy academics—Michael Porter (keynote speech), David Blumenthal (keynote speech), Don Berwick, and Chris Murray. more…

Colin D Butler: Regional overload and the consequences it has for health

20 Jan, 17 | by BMJ

Almost 1% of the world population, mostly children, is forcibly displaced (including 11.7 million Syrians), an increase of over 50% from 2011. [1] Here I propose that the public health catastrophe in Syria be conceptualized as a canary case of “regional overload,” relevant to the emerging public health sub-specialty of planetary health. [2,3,4] more…

Neel Sharma: Fired up, ready to go!

20 Jan, 17 | by BMJ

neel_sharmaAlthough I’m not usually political by a long shot, the presidential transition in the US today has made me reflect on Barack Obama’s legacy and his mantra of: “Fired up, ready to go!”

I transplanted these words temporarily and thought back to where I currently stand as a junior doctor. When I left medical school I was naïve. I assume most of us were. We eventually realise when we begin to practice medicine, that the system that we work in is not always so conducive to effective working practice. I’m sure readers are avidly digesting the state of the NHS this winter. I also realised that as juniors we focus on safe and effective patient care, but our focus can be distracted by our worries of what those above us think. more…

Jeffrey Aronson: When I use a word . . . Discovering lithium

20 Jan, 17 | by BMJ

jeffrey_aronsonThere are many ways of discovering effective medicines. One can, for example, investigate herbal remedies, endogenous agents in animals and micro-organisms, or drug metabolites; use applied pharmacology and empirical chemistry; or implement rational design based on a target or pathophysiology. Not infrequently chance plays a part, as in the case of lithium.

Two hundred years ago, in 1817, Johann August Arfwedson (1792–1841), working in Sweden in the laboratory of Jons Jakob Berzelius (1779–1848), studied the properties of a feldspathoid mineral ore called petalite, which a Brazilian chemist and statesman, José Bonifácio de Andrada e Silva (1763–1838), had discovered in 1800 on Utö Island, off the coast of Sweden. The IndoEuropean root PETƏ, to spread, gives us words such as more…

What can we learn from the European Union’s first right to food Law?

20 Jan, 17 | by BMJ

In this second article on the #RightToFood, part of a BMJ Global Health series, we discuss our experience of the conception and enactment of a right to food law in Lombardia, Italy. The “Recognition, Protection and Promotion of the Right to Food,” was approved by the Lombardia Regional Council in November 2015. The law was the first to recognise this right within the European Union and was the result of a desire to have a policy in place after EXPO Milano 2015, in line with the Milan Charter and its recognition of the right to food as fundamental right. In our opinion, the law rightly approached the problem holistically and recognised the importance of locally based food systems and democratic participation in order to fully guarantee the right to nutritious food. However, its implementation is still lagging behind expectations. more…

David Kerr: Big pharma in Trumpland

19 Jan, 17 | by BMJ

david_kerr_2015picDonald Trump has big pharma in the crosshairs. Using classic #TrumpSpeak, the soon to be 45th President of the United States hinted recently that Medicare, the biggest buyer of drugs in the US, could soon be able to negotiate drug prices directly with the pharmaceutical industry.

This is something big pharma has spent years and millions of dollars in trying to prevent. According to Trump, the pharma industry “has been getting away with murder . . . we’re the largest buyer of drugs in the world and yet we don’t bid properly and we’re going to start bidding and we’re going to save billions of dollars.” Unusually, given the current combative nature of domestic politics here in the US, his idea has also been espoused by political opponents including Bernie Sanders and Hillary Clinton. Although short on detail, Trump’s comments caused big pharma to lose almost $25 billion in market value the same day. more…

Yuhong Zhu: School bullying in China calls for holistic interventions and prevention

19 Jan, 17 | by BMJ

Recently there has been a lot of discussion on social media in China about bullying at school and the effect that it has on children’s mental health. Bullying is emerging as a pressing social issue in China, and the literature provides evidence that bullying is a globally pervasive problem.

Bullying is an extremely difficult life experience, with lasting and serious negative effects on learning and academic achievement, physical health and neurobiology, social relationships, and mental health—not only for those who are bullied, but also for the bullies and those that witness bullying.

The largest area of longitudinal research on bullying is the study of how bullying affects mental health more…

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