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Julian Sheather: Time to debate the ethics of robot care?

17 Apr, 14 | by BMJ

We take it for granted that compassion is at the heart of good care. But what if the hand that reaches out to yours is a robot’s? What if the last face you see on earth is a facsimile? The use of robotics is well established in parts of medicine. Surgery involving remote manipulation of robotic arms is now commonplace. Some have even predicted that surgery will cease to leave a scar: introduced via orifices, robots will travel to the afflicted area, self-assemble and do their robotic thing. But by and large these remain an extension of ordinary human tools—just better. Fully-autonomous robots, our companions and servants—even our nemeses—have not made it far from the pages of science fiction. As an editorial in The Economist has it, set aside car manufacturing and vacuum cleaning, robots have been more successful at parsing our anxieties about technology than delivering real world promise.  But things might be changing. Scientists at Ohio State University have developed an algorithm that enables computers to read human emotions. Google and Amazon are both investing heavily in robots. Big data, cloud computing and the ever-growing crunching power of ever-shrinking processors suggest that robotics may be about to take an automated leap forward. more…

The BMJ Today: Further adventures of the polypill

17 Apr, 14 | by BMJ

TJackson_09Remember the polypill, the combination of several active ingredients in one tablet that promised to revolutionise the prevention of cardiovascular disease? It is a question we have often asked in the offices of The BMJ, the journal in which the idea of the polypill was first mooted in 2003 by Nicholas Wald and Malcolm Law. In their paper, “A strategy to reduce cardiovascular disease by more than 80%,” they envisaged a single pill comprising aspirin, a statin, folic acid, and three types of antihypertensives. This, they claimed—if taken by everyone 55 and older and everyone with existing cardiovascular disease—could largely prevent heart attacks and stroke. A linked editorial proclaimed it as,  “one of the boldest claims for a new intervention.” more…

Jim Murray: Abbvie withdraw case against European Medicines Agency

16 Apr, 14 | by BMJ

jim_murrayAbbVie have withdrawn their legal challenge against the release of certain company documents on Humira (adalimunab) by the EMA. This followed an offer by the agency to redact parts of the document originally intended for release.

Is this good news? There are those who think it is, but we cannot be entirely sure at this stage, and may never know for certain unless someone manages to see the parts that were redacted. more…

David Oliver: How real life stories can help us understand the challenges of care for older people

16 Apr, 14 | by BMJ

david_oliverOn television we can often tell more from peoples’ words or reactions than from any scripted voiceover. In “Protecting our Parents”—a three part BBC 2 documentary, due to be screened on 17 April, this holds very true.

Our society is often afraid to face up to the realities of old age, and a youth fixated broadcast media compounds this. Yet here, we have a moving, thought provoking, and beautifully constructed series, courageous enough to highlight the dilemmas faced by those at the extremes of age and frailty, and when confronted with life changing decisions at the interfaces between remaining at home, being in hospital, or requiring long term care and support. The light touch used by the programme’s makers allows us to draw our own conclusions rather than be steered, and to appreciate that these dilemmas come in many shades of grey and have no perfect solution or neat resolution. The cases are entirely typical of the work many of us do day in day out in frontline services. more…

The BMJ Today: Why does female genital mutilation persist?

16 Apr, 14 | by BMJ

rich_hurleyA news story by Clare Dyer and a rapid response from the director of public prosecutions in England and Wales, Alison Saunders, keep The BMJ’s spotlight on female genital mutilation.

For a long time these horrific practices were downplayed as “circumcision” or “cutting.” But female genital mutilation includes, without medical indication, excision of all or part of the clitoris, possibly removal of the labia, and, at its most extreme, closure of the vagina. more…

Kailash Chand: The survival of general practice is the survival of the NHS

16 Apr, 14 | by BMJ

Kailash ChandGeneral practice in England is under intense pressure at the moment from a variety of sources, including the plan to keep surgeries open from 8am to 8pm, seven days a week. These are combining to overstretch practices in an unsustainable manner.

A key factor is that patient demand is constantly increasing because of an ageing population. By 2011 the number of people aged over 65 had surpassed 10 million, and by 2031 it is predicted to hit a new peak of over 15 million. As many of these patients enter their 70s and 80s, they will develop increasingly complex health needs that require longer consultations and more intense, complicated care from their general practice. By the beginning of the next decade, there will be one million people living with dementia alone, while many more will have other conditions such as heart disease, diabetes, and additional degenerative conditions. In the majority of cases an older patient will have a number of these conditions at the same time. more…

Candace Imison: The future provider landscape—are foundation trusts taking us down a dead end?

15 Apr, 14 | by BMJ

candace_imisonA year ago NHS commissioning was ripped up by its roots, divided up and then pushed back into the soil. Like the plants in my garden that get such rough treatment, commissioners are struggling to flourish. The NHS provider architecture has, so far, had more gentle treatment, and the journey towards “liberalisation,” that started in 2004 with the establishment of the first foundation trusts, continues. more…

Nick Harvey: There’s now a cure for hepatitis C… but the poor can’t afford it

15 Apr, 14 | by BMJ

nick_harveyPicture the scenario: a disease is destroying your liver and there’s a chance you will die. There’s a cure, but you can’t have it as it costs more than you earn. There are tens of millions more of people like you. Hundreds of thousands of them die every year.

It sounds like some sci-fi dystopia, but this is the situation that the 150 million people who have hepatitis C virus (HCV) find themselves in today. HCV is spread through blood-to-blood contact, mostly through shared needles. Around 350,000 people die of HCV related liver complaints each year, but new drugs have been developed within the last six months with cure rates higher than 90 per cent. more…

The BMJ Today: GSK and paying doctors to speak on its behalf

15 Apr, 14 | by BMJ

Deborah CohenOn 17 December last year, UK pharmaceutical giant, GlaxoSmithKline, made a bold pledge. From 2016, the company said, it will stop paying doctors to speak on its behalf or to attend conferences to end undue influence on prescribers.

Not only that, drug reps were no longer going to be paid according to the number of prescriptions they solicited from the doctors they saw. The announcement drew both plaudits and scepticism. more…

Richard Hurley: Why the food industry doesn’t find a sugar tax so sweet

15 Apr, 14 | by BMJ

rich_hurleyA flurry of media attention followed England’s Chief Medical Officer Sally Davies’s recent admission that a sugar tax may have to be considered to try to reverse the overweight and obesity that now afflicts a third of UK children.

Such a tax might reduce consumption, the theory goes, by reducing demand for energy dense foods because they would be less affordable. Or it might reduce supply because competition would encourage manufacturers to make their products healthier. more…

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