History has witnessed numerous drug patent wars, but in April 2013, the Indian Supreme Court did something which captured the attention of the international media. It denied a patent to the beta crystalline form of Imatinib mesylate, a life saving anticancer drug, to the Swiss pharmaceutical company Novartis. The verdict was noteworthy because this drug is patented in more than 38 countries including the US, Russia, and China. Today this drug is being manufactured by generic drug companies in India. Is this a victory against the monopoly of pharmaceutical giants, or has India set a dangerous precedent which will discourage the innovation of future drugs? more…

This season’s hot topic is urgent care, particularly in relation to primary and community based care. Before we get carried away with patchwork top down answers, we need to make sure that changes come from genuine “clinical leadership.” Clinical Commissioning Groups (CCGs) are best placed to make this happen.

To achieve the transformative change that we need to see in the health system, we need genuine clinical leadership. “Clinical leadership” is the buzzword of the day, but what does it actually mean?

It does not mean “clinical engagement,” which is more of an—”agree with us”—change.  It also doesn’t, in my view, simply mean doctors as bosses.  What it does mean is clinicians responding to problems with solutions that come from clinicians. more…

One of the most enthralling articles that caught my attention last month was one entitled “Knowledge and practice of clinical ethics among healthcare providers in a government hospital, Chennai” published in the Indian Journal of Medical Ethics. It revealed that 30% of the responders did not give a definition of healthcare ethics (and I am inclined to think they did not know what it is), and 40% did not name a single ethical principle (again, I suspect they did not know of any). What I found more alarming was the fact that, “25 out of 51 physicians stated that they did not have time to listen to their patients.” 25 out of 51 physician responders also did not respond to the part of the questionnaire that asked them to name the principles of the Hippocratic Oath. All this makes me think that medical ethics in India is not well known, or adhered to strictly enough. more…

I couldn’t be more serious in beginning to reflect on the Francis report with a joke. The joke is employed by Slovenian philosopher Slavoj Zizek in his illustration of ideology, quoting from the director Ernst Lubitsch’s film Ninotchka. In this film, the hero visits a cafeteria and orders coffee without cream; the waiter replies: “I’m sorry, sir, we have no cream. Can it be without milk?” For Zizek, the philosophical import of this joke expresses the Hegelian notion that “what you don’t get is part of the identity of what you do get.” The Francis report is a strong cup of coffee, but in the interests of our patients we should be more mindful of what was left out. more…

Fran Baum is blogging from the 8th World Health Organization Global Health meeting. Read her other blogs here.

The morning session of the final day of the WHO 8th global health meeting (8GCHP) had many contributions looking to the future. Heidi Hautala, minister for internal development, Finland, spoke of the importance of woman in development, noting that child survival increases by 20% when the mother controls the household budget. She stressed that the Millenium Development Goals post 2015 must address health inequities. Eduardo Espinoza, minister of health, El Salvado, gave an impassioned plea for a rejection of what he described as “an irrational addiction to an outdated model of economic growth,” which ignores people’s and the environment’s needs. He stressed that El Salvador’s health reform has been based on social participation and broad intersectoral effort to deepen understanding of and action on social determinants of health. He said they assessed the health impact of industry including mining and agriculture and then regulated to protect health. Roopa Dhatt (President of International Federation of Medical Students’ Associations) representing the voice of youth gave young people’s vision for the future of health—stressing the need for a systems view considering sustainability, health, and wellbeing. Hoda Rashad, Egypt, emphasised that health equity must become the benchmark of a country’s success. more…

Success in reducing mortality from cardiovascular disease combined with improvements in cancer survival mean that the number of people at risk of being diagnosed, or living with cancer, is increasing. In a few years, half of all Britons will be likely to be diagnosed with cancer at some time in their life. By 2040 a quarter of all pensioners will be cancer survivors.

These statistics are great for concentrating the mind, but what are the solutions? We should continue to pursue technological innovations that will enable the advent of better cancer tests and treatments such as new genetic biomarkers and drug therapies. However, we can also improve cancer outcomes by trying to reduce population wide variation in cancer prevention, diagnosis, and treatment. Of course the two paradigms are complementary. Every year, I greatly enjoy attending the “Cancer Outcomes” conference, which is a conference “home” for the large number of cancer charities, clinicians, researchers, and policy makers who support population based approaches to improving cancer outcomes. more…

JAMA  12 June 2013  Vol 309
2345   “Moral panic” is a term which dates back to the 1830s and describes “an intense feeling expressed in a population about an issue that appears to threaten the social order.” Just now the Chief Medical Officer for England is putting her weight behind a campaign of moral panic about antibiotic overuse by doctors, and if I dissent I shall be considered a threat to the social order. We are supposed to confess that as GPs we greatly overuse antibiotics, and as a result they are losing their effectiveness and we are about to return to the pre-antimicrobial era. The study reported here from the USA shows that primary care paediatricians can be persuaded to use fewer broad spectrum antibiotics for respiratory infections in favour of amoxicillin and penicillin V. The fact is that after 60+ years of “overuse,” these remain highly effective first-line treatments in primary care, and you don’t need most of the rest. We may differ on the likelihood of their usefulness in particular clinical contexts, but there is no room for moral panic. Dame Sally should save that for the use of antibiotics in animal feed.
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Helsinki in summer is a delight, its streetscapes of Russian influenced architecture illuminated and lifted by the interplay of the midnight sun and the ever present sea. The occasion was the triennial joint congress of five Finnish societies for research in ageing, a vibrant meeting of over 800 scientists, researchers, and clinicians.

Once again, I was reminded of why meetings and congresses make sense, even with all the video- and tele-conferencing possibilities open to us. The interaction of delegates, the emergence of fresh ideas, the sense of community, the human interest, and in particular humour, are a formidable counterblast to the inevitable routine and the grind of research and practice. more…

Two recent stories provoked a fascinating discussion on misconduct in research—that have nothing to do with the authors, and in the most unlikely of journals. The May 15th edition of the Journal of Applied Physiology explored these two cases in detail. There was no suggestion of research misconduct by the authors, but these controversies introduce a whole new perspective into the ethics of research. Pater Wagner explains what he did in his editorial, “When worlds collide—elite sport, doping, and scientific research.” Take a look at the brief histories below—and see what you think? more…

Fran Baum is blogging from the 8th World Health Organization Global Health meeting. Read her other blogs here.

Yesterday was “Europe Day” and the impact of the financial crisis in Europe was at the forefront of people’s minds. Many talked of its health impact and especially the devastating impact of high unemployment. Zsuzsanna Jakab, World Health Organization regional director for Europe, spoke about her region’s Health 2020 strategic objectives which aim to improve health and reduce the health divide through leadership and participatory governance for health. She spoke of the economic burden of chronic disease and the need to use fiscal measures to control risk factors. I was very impressed that she didn’t mention behaviour change strategies—there has been progress in health promotion! more…