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of health, El Salvado, gave an impassioned plea for a rejection of what he described as “an irrational addiction to an outdated model of economic growth,” which ignores people’s and the environment’s needs.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…

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

It was good to hear Pekka Puska present Finland’s health promotion success which has resulted in an 80% reduction in cardiovascular disease over 30 years. He stressed that this has been a long term complex process. The Finns realised early on that victim blaming doesn’t work and that changing the environment is vital. So they regulated food supply so it was lower in fat and salt and worked with the food industry to encourage them to make food healthier. Subsidies for dairy products were reduced and dairy farmers were encouraged to change to berry farming. Finland’s experience raises the question of how governments globally can get “Big Food” to change its addiction to sugar and fat? more…

It’s not just me who is annoyed about the presence of Bounty reps on NHS wards, who pay the NHS to be allowed access to give samples of products to new mothers—and who earn money from selling on parents names and addresses.

I wrote in the BMJ that, “The lack of knowledge about what signing over your details means is troubling in a hospital environment, which should take consent and confidentiality seriously. The hours after birth are hardly an optimal time to obtain formal consent. And is the presence of a non-essential Bounty worker on the ward desirable?” Mumsnet ran a web based survey of 1000 women, asking them what they thought. Just over half felt their privacy was invaded, and 60% didn’t realise that their details would be sold on. 82% didn’t think that Bounty should have access to NHS wards at all. more…

I was at a conference on doctors and social media recently, sharing a platform with the GMC. The organisers put up some darkly funny tweets by doctors at the ends of their tethers, usually fired off in the small hours. There were jokes at the expense of patients and juniors, managers and colleagues…The question for the GMC and me was, more or less, should doctors be posting this stuff? Is it ethical and, slightly more urgently, will the GMC be after them if they do?

Social media are powerful tools and in some form or other are probably here to stay. But among a great many things that are useful lurk a few hazards for the unwary doctor. One of these is the way social media can blur the distinction between our public and private lives. Reading those tweets at the conference—so much compressed spleen—was like watching the collective medical unconscious rear its head: a 4 am outpouring of rage, frustration, and plain disbelief. more…