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John King: Adapting to Brexit

31 Aug, 16 | by BMJ

john_king3As the shock of the referendum fades away, a deathly silence has come over the remain camp. The defeated remainers have gone to ground, while the process of leaving the EU has taken on a life of its own. All the talk is of Brexit, for “we are all Brexiters now.” In a sense this is understandable as there appears to be no way back: many European countries are keen to be rid of us, having cast ourselves adrift through our own folly, and with every passing week there is even less chance to clamber back aboard the mother ship.

So how are the survivors coping? more…

Wendy Reid: Postgraduate medical training in the NHS: complex and transforming

31 Aug, 16 | by BMJ

Wendy_Reid2Junior doctors’ anger and disillusionment during their recent dispute highlight the need for a new approach to ensure that they feel valued and able to work in supportive and accountable environments.

Rather than wait for the contractual dispute to be resolved, Health Education England (HEE) has been working with others, including postgraduate deans, the BMA’s Junior Doctors Committee, NHS Employers, and the Academy of Medical Royal Colleges (AoMRC), to address some of these challenges. more…

Elizabeth Loder: Should orange be the new black for price-gouging pharma execs?

31 Aug, 16 | by BMJ

elizabeth_loder

One thing’s for sure: Heather Bresch, the CEO of Mylan Pharmaceuticals, looks good in orange. She’s the subject of a recent New York Times article that opens by declaring “America has a new pharmaceutical villain.” (Martin Shkreli, former CEO of Turing Pharmaceuticals who raised the price of an essential toxoplasmosis drug by 5000%, is the old villain, of course.) The piece describes the public outcry in the US over enormous price rises for the company’s life-saving EpiPen® product. It details the many company activities, overseen by Bresch, which made those increases possible. It’s a sordid, unedifying tale. Bresch is pictured alongside the Times article wearing a stylish orange dress. Judging by the tone of some of the article, it makes you wonder if instead she should be wearing an orange prison jumpsuit? more…

Nick Hopkinson: The burden of asthma—how to frame it and what needs to be done?

31 Aug, 16 | by BMJ

A study this week from the Asthma UK Centre for Applied Research at the University of Edinburgh, widely reported in the media, estimates that asthma costs the UK £1.1 billion/year in direct healthcare and disability allowance payments. News reports focused on the scale of these costs and the suggestion that 1100 people are dying “needlessly” each year.

Some of these deaths do arise from poor care—the Royal College of Physicians report Why asthma still kills contains examples. Yet the finding that many deaths are preventable with optimal long term treatment, self-management, and emergency care does not mean that their prevention is straightforward more…

Claire McDaniel and Daniel Marchalik: Drawing a line in research

31 Aug, 16 | by BMJ

The Doctor’s Book Club
Lily King’s Euphoria

The woman is perfected.
Her dead
Body wears the smile of accomplishment,
The illusion of a Greek necessity
Flows in the scrolls of her toga
— Sylvia Plath “Edge”

Set in the 1930s, Lily King’s Euphoria tells the story of the river tribes of New Guinea and the anthropologists who studied and lived among them. A quasi-fictionalized account, the story is based on the lives of famed anthropologist Margaret Mead, her second husband Reo Fortune, and her third husband Gregory Bateson, the trio of anthropologists who redefined the essence of social science research. more…

Kawaldip Sehmi: Shopping around for the best system of universal health coverage

30 Aug, 16 | by BMJ

Kawaldip SehmiIn September 2015, 194 member states of the United Nations agreed to adopt the resolution A/RES/70/1 from Transforming our world: the 2030 Agenda for Sustainable Development. By accepting this resolution they have set themselves 17 social, economic, educational, and health goals to achieve by 2030.

Sustainable Development Goal 3 (SDG 3) declares that the state will ensure healthy lives and promotes wellbeing for all at all ages. Potentially, the most important sub-health goal is SDG 3.8—each country will establish a system of universal health coverage (UHC), including financial risk protection; access to quality essential healthcare services; and access to safe, effective, quality and affordable essential medicines and vaccines for all by 2030. more…

Richard Smith: Making workplace health work after 40 years of failure

30 Aug, 16 | by BMJ

richard_smith_2014What is it that makes a company successful? Could it be strategy, leadership, funding, great products, luck, or something else? All of those things are secondary to the “essence” that make for a successful company—which is the habits of the employees—argued Andrew Sykes, an actuary who is the founder of a company called Habits at Work at a C3 Breakfast last week. C3 is a global charity that works to prevent non-communicable disease.

We tend to think of bad habits, but there are also good habits. Good habits mean that employees do the right actions over and over again. Habits, said Sykes, are like the gene code of the company, running through every action, and can be compared to compound interest, which may not seem important day to day but can over time grow an investment hugely. Sykes divides habits into habits that are related to work and pivotal habits that drive the life and work of us all. more…

Richard Lehman’s journal review—30 August 2016

30 Aug, 16 | by BMJ

richard_lehmanAfter a month’s break, I’m catching up with articles of interest in the main non-BMJ journals throughout August. Normal service will be resumed next week. 

NEJM  Aug 2016  Vol 375

No parasites for five years

405   Following its famous “data parasites” editorial last January, the NEJM has struggled to find a comfortable position on the issue of opening up trial datasets for independent analysis. In its first print issue for August it hosted four Viewpoint articles offering a range of options, mainly for the sharing of trials conducted by academic centres. Completely open sharing does not get a mention—the idea that researchers should make their de-identified data available without restriction. The NEJM spectrum instead begins with the Yale Open Data Access project, of which I’m a proud founder member. We pioneered the “academic intermediary” model and still run one for those who wish to use it. If researchers want to use more direct methods of sharing data, we’re hardly going to stop them. But alas, the very opposite tends to be true. A piece from a hitherto unknown body called The International Consortium of Investigators for Fairness in Trial Data Sharing argues that researchers should retain sole use of their databases for up to five years. I’m genuinely sad and baffled that people with prosperous careers supported by public funding can argue that the research they have performed through the altruism of unpaid people taking voluntary risks is somehow their private property. more…

John Davies: Providing medical care in rural Brazil

26 Aug, 16 | by BMJ

Rio_Olympic_GamesThe Olympic Games are over, and what a wonderful two weeks they were. We finished the last events at the Olympic Stadium the day before the last day and there was a slight element of going mad. Hundreds of volunteers flooded onto the track. Shirts of different colours were swapped, and there were selfies and mass group photographs in all directions. No one was immune from the wonderful Brazilian enthusiasm for having good time. more…

Jeffrey Aronson: When I use a word . . . Junior

26 Aug, 16 | by BMJ

jeffrey_aronsonThe President of the Royal College of Surgeons of Edinburgh has asked Jeremy Hunt, the secretary of state for health (the SoSH), in a letter that also dealt with other more important matters, to find a less pejorative term to describe “junior” or “trainee” doctors, since “they are highly skilled, dedicated professionals and should be recognised as such.” Possible alternatives include “young doctors” and “non-consultant hospital doctors,” which isn’t very catchy; another suggestion, “Doctors In Training,” would make them acronymically ditzy. more…

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