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Richard Lehman’s journal review—31 May 2016

31 May, 16 | by BMJ

richard_lehmanNEJM 26 May 2016 Vol 374
An end to oncology drug madness?
2001 “Seamless Oncology-Drug Development” is a viewpoint piece about the research and regulatory changes that have allegedly been driven by a desire for “early access to transformative new anticancer drugs.” To my simple way of thinking, this would mean first showing that the new drug was transformative, through large double-blinded randomised controlled trials demonstrating a sizeable survival benefit. Secondly, in order to achieve “early access,” the drug would then be immediately available to all patients, and charged at production cost to the health provider. Thirdly, further trials would be conducted using it earlier in the disease process, compared to existing standard treatment. more…

Linda Bauld: The road to standardised tobacco packaging in the UK

31 May, 16 | by BMJ

linda_bauldEvery year in the United Kingdom around 200 000 children start smoking. Half of those who try a cigarette will become regular smokers, putting themselves at risk of tobacco related diseases that can shorten their lifespan by at least a decade. Because of this, the UK and other governments have implemented a range of tobacco control measures over many years, which are intended to both prevent smoking uptake and encourage smoking cessation. Key among these have been measures to restrict the ability of the tobacco industry to market their products to new and existing smokers.

Firstly, traditional forms of advertising such as TV and billboards were banned, followed by sports sponsorship, and, most recently, point of sale displays in shops. All that was left was tobacco packaging: a way to communicate to consumers the appeal of the product and to promote different brands. more…

The SOCHARA Team on providing community health in India

27 May, 16 | by BMJ

The Society for Community Health Awareness Research and Action (SOCHARA), an Indian NGO, is recognised widely for its promotion of community health through networking, innovative training, research, policy engagement, and solidarity with movements and networks such as the People’s Health Movement, medico friend circle, and COPASAH. Recently the occasion of SOCHARA’s silver jubilee gave us the opportunity to reflect on 25 years of experience. The SOCHARA family is large not just because of the “once you enter, you will always be a part” culture but also for its partnerships and solidarity. This was well reflected in the diversity of participants at the meeting. Also in attendance were those who received and continue to receive mentorship in their respective community health journeys from SOCHARA members over the years. Our ethos of social justice, scholar activism, and non-hierarchy have reportedly played a role in shaping the work culture of several individuals and organisations. more…

Jamie and Sue Mumford: Palliative care in Ethiopia

27 May, 16 | by BMJ

palliative_care_ethiopiaWe have recently returned from our fourth visit to Addis Ababa. With less than 1% of the estimated 150,000 new cancer cases annually in Ethiopia receiving specialist oncological treatment [1], the need for affordable palliative care in the country is huge.

Hospice Ethiopia, the only palliative care unit in the country providing symptom control treatment, was set up in 2003 by Sister Tsigerada Yiswafossen. It is a non-governmental organisation and as such has to raise 90% of its funds from outside the country. When funding is dependent on donors there is a continuous need of international and domestic networking. more…

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

27 May, 16 | by BMJ

jeffrey_aronsonThe village of Erice sits above the town of Trapani on top of a mountain about 750 metres above sea level in the north-west corner of Sicily (picture below). Its original name was Ἐρυξ, after the Sicilian king of that name, a son of Aphrodite and either Boutes, an Argonaut, or Poseidon, the god of the sea. Eryx ruled over the Elymoi in western Sicily. When Herakles visited the island, Eryx challenged him to a wrestling match, staking his land against Herakles’s cattle. Herakles killed him and Eryx was buried on the mountain where he had erected a temple to his supposed mother, Aphrodite. more…

Zosia Kmietowicz: A charter for women who are pregnant in prison

27 May, 16 | by BMJ

zosia_birth_charter_blogIt is 20 years since a TV documentary showed a British prisoner give birth while handcuffed to a prison guard. Anyone who remembers the images must be asking why a charter for improving the care of pregnant women in prison and their babies has just been launched. Surely this doesn’t happen anymore?

According to Birth Companions—the charity set up in the wake of the 1996 programme—many pregnant women and new mothers in prison still do not get the care and support they are entitled to. more…

Lawrence Loh: Public health and why terminology matters

26 May, 16 | by BMJ

Lawrence_Loh_picAs younger generations of physicians develop a newfound interest in the social determinants of health, public health has increasingly become a buzzword for providers to throw about. In the medical community, it is now more and more common to find someone who is “practising” public health. But are they?

Having worked as a public health physician for five years, I am slowly beginning to notice subtle distinctions between practising public health and incorporating a public health issue into one’s practice. Many conflate the two, but these are not the same thing. more…

Claire McDaniel and Daniel Marchalik: Considering patients’ stories through Adam Johnson’s The Orphan Master’s Son

26 May, 16 | by BMJ

After her son was arrested by the secret police, Anna Akhmatova spent seventeen months waiting outside the Leningrad prisons for news of his wellbeing. Standing next to scores of other women similarly hoping to hear that their loved ones were alive, Akhmatova composed “Requiem,” a lyrical poem that explores the helplessness of living in a totalitarian state:

I’ve cried for seventeen long months,
I’ve called you for your home,
I fell at hangmen’ feet—not once,
My womb and hell you’re from. more…

Evidence Live 2016: Promoting informed healthcare choices by helping people assess treatment claims

26 May, 16 | by BMJ

Iain Chalmers, Paul Glasziou, Douglas Badenoch, Patricia Atkinson, Astrid Austvoll-Dahlgren, and Andy Oxman.

In the run up to Evidence Live 2016, we are running a series of blogs by the conference speakers discussing what they will be talking about at the conference.

All of us are bombarded by treatment claims. These reach us through the media, from people selling treatments, from academics, from health professionals, and from relatives, friends, and people we happen to bump into.

How should people making health choices assess the trustworthiness of such claimed effects of treatments? In particular, how should research evidence play into our assessment of these treatment claims—whether for treatments for something as trivial as a cold, or as life threatening as cancer, or anything in between? Whatever the issue, those making treatment choices have the greatest vested interest in knowing how to go about assessing claims about the effects of treatments because it is they who stand to lose or benefit from the choices they make. more…

Suzanne Gordon: What we call healthcare professionals matters

25 May, 16 | by BMJ

suzanne_gordonThe other day I attended a patient safety workshop at a major US hospital. The physicians and nurses, IT, and other quality and safety staff in the room were deeply concerned about the latest report in The BMJ documenting that 250,000 patients a year die from preventable errors, making this the third leading cause of death in the US. Almost all the attendees agreed that learning concrete teamwork skills and flattening hierarchies is critical to patient safety as well as job satisfaction, employee engagement, and staff retention. And yet, as the attendees shared their concerns and experiences, almost all of them used terms that are inherently anti-team and reinforce the steepest healthcare hierarchies. more…

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