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Anita Jain: Overdiagnosis—when is it too much care?

21 Oct, 14 | by BMJ

“Come over for a discussion on overdiagnosis and contribute your ideas to tackle it,” was the invitation. A diverse mix of doctors, nurses, researchers, public health practitioners, and students from countries across the world got together for our workshop at the 22nd Cochrane Colloquium in Hyderabad.

Overdiagnosis, like many medical conditions, lacks clear parameters. How much is too much, really? more…

The BMJ Today: England’s ongoing battle with liver disease

21 Oct, 14 | by BMJ

Today, The BMJ reports the stark warnings from public health experts about the rate of mortality from liver disease in England, and the regional variation across the country.

As Jacqui Wise reports, new profiles from Public Health England show that male mortality rates from liver disease are four times higher in some local authority areas than in others. The profiles also show large variation in hospital admissions for liver disease in different parts of the country. more…

Kate Adlington: Should the UK move towards greater regulation of doctor-industry relations?

20 Oct, 14 | by BMJ

kate_adlington_picInternational interest in the interaction between physicians and industry has been mounting since the Physician Payment Sunshine Act (PPSA) was passed in the United States in 2012. The first data made available as a consequence of this act were published last week by the Centers for Medicare and Medicaid Services (CMS). The BMJ published their own rapid analysis of this information, which covers all payments made by US drug and device makers to US doctors in the last five months of 2013. more…

Surayya Johar: Open Access Week—the next generation

20 Oct, 14 | by BMJ

Surayya_JoharOpen Access Week, a global event now entering its eighth year and running from 20-6 October, is an opportunity for the academic and research community to continue to learn about the potential benefits of open access, to share what they’ve learned with colleagues, and to inspire wider participation in helping to make open access a new norm in scholarship and research.

BMJ Open takes a closer look at this year’s theme as announced by the Scholarly Publishing and Academic Resources Coalition (SPARC): “Generation Open.” As explained by SPARC, this theme represents the role of the next generation of open access advocates, and also what impact any changes within scholarly publishing may have upon the careers of scholars and researchers. more…

Richard Lehman’s journal review—20 October 2014

20 Oct, 14 | by BMJ

richard_lehmanNEJM 16 October 2014 Vol 371
1507  I hate military metaphors for cancer as much as anybody, but here is a study which describes hell in the leukaemia trenches. The 30 patients in the trial had acute lymphoblastic leukaemia. The youngest was 5 years old; most were under 20. All of them had relapsed after initial chemotherapy, which heaven knows is bad enough. Eighteen had then endured the horrors of allogeneic stem cell transplantation, and then relapsed again. Some had been through other experimental treatments. Now they were given an infusion of autologous T cells transduced with a CD19-directed chimeric antigen receptor (CTL019) lentiviral vector. In all of them, this caused a cytokine release syndrome, which was severe in over a quarter of cases and had to be treated with the anti–interleukin-6 receptor antibody tocilizumab. The complete remission rate at the end of all this was 90%. So victory at a high price: the challenge now is to operationalise this treatment in a way that is bearable to patients and affordable to health systems. more…

The BMJ Today: How “political” should The BMJ be?

20 Oct, 14 | by BMJ

At the Royal College of Physicians’ Harveian Oration last week, a doctor told me The BMJ had become a “political” rag. And it was not the first time that the accusation has been made. So when are medical and healthcare issues purely scientific matters and when are they “political?”

Dr Michael O’Donnell, former editor of World Medicine, and the subject of our BMJ Confidential column this week, believes that the organisation of healthcare has always been a political matter. His current day job is writing an eyewitness account of the rise and fall of the NHS. He calls Aneurin Bevan “a shrewd political operator,” not least because of the time it has taken “for those who wished to destroy the NHS to make any progress.” more…

Amy Price: Patients doing research for themselves

17 Oct, 14 | by BMJ

Amy_price_picPatient rights and empowerment movements have grown exponentially over the last decade. Shared data movements and clinical decision making may employ slogans like “having a voice,” “nothing about me, without me,” and “give me my damn data,” all these expressions share the language of loss and blame. Vision and partnership are not built by crying for what we do not have, but instead by realistically assessing the situation as it is and working to build collectively what we have. (Price, Biswas & Biswas, 2013)

Some patients have done just that. In a recent BBC programme, Vivienne Parry interviewed those who have dared to engage in patient led research, and who have subsequently challenged and enriched the medical establishment. more…

The BMJ Today: Aiming for a culture of safety not perfection

17 Oct, 14 | by BMJ

kate_adlington_picDo you believe in the “boundless capacity of medical science?”

In a philosophical podcast to accompany this week’s analysis article, Professor Jerome Hoffman and Dr Hemal Kanzaria, of the University of California, suggest that efforts to reduce overdiagnosis and overtreatment should focus on changing physician and public attitudes towards medical error and uncertainty. more…

Yvonne Obura: Female genital cutting—improving doctors’ awareness

17 Oct, 14 | by BMJ

UK PM David Cameron attends the 'Girl Summit 2014' in London.Female genital cutting (FGC) or mutilation (FGM) is the removal or injury of the external female genitalia for non-medical purposes. It is estimated that 125 million women and girls worldwide are currently living with the effects of FGC, and a further 30 million girls are at risk of being cut within the next decade.

According to a recent study, 137 000 women and girls living in England and Wales have undergone FGC. Since 2008, around 1.5% of all women giving birth in England and Wales had undergone FGC, of which 60% originated from the Horn of Africa. more…

Carolyn Thomas: My experience of patient peer review

16 Oct, 14 | by BMJ

carolyn_thomasI’ve finally hit the “Submit” button on my patient review of a research paper submitted to The BMJ—and in time for its deadline. Hurray!

This is the first project of this type I’ve ever been involved in, and at first blush I wondered if I would have anything at all meaningful to contribute—as a non-scientist who wouldn’t know a Hosmer-Lemeshow test from my left elbow at the best of times. more…

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