About 10 months ago I blogged that an exodus of doctors from Portugal would be a sign of Portugal’s worsening economic situation. Medicine has always offered one of the few stable and prosperous careers. Most doctors are still in employment, and our income levels are usually above the national average as many doctors juggle professional commitments in both the public and private sector. more…

The announcement last week of the design of the NHS Commissioning Board is critically important. It signals the end of the prolonged period of ambiguity which managers have experienced since the white paper was published in July 2010. For those who have been through the round robins of previous reforms there is a realisation that this time it is not about “rearranging the deckchairs.” Everyone is coming up hard against the fact that the way we have done commissioning in the past will not suffice in the future. more…

“Poisonous hip implants ‘putting thousands of British patients at risk’ as medical watchdog launches investigation,” a Daily Mail headline announced today.

It followed on from a front page splash in the Sunday Telegraph which claimed that “metal-on-metal” hip devices are “even more dangerous than previously thought.”

This isn’t a new story—but finally people are waking up to the scale of the problems caused by the device regulatory system in Europe. First there was public outcry over faulty PiP breast implants, and now controversies that have been surrounding metal on metal hips for some time are gathering momentum. more…

The second day of the festival began with Jude Kelly, the artistic director of the Southbank Centre, explaining that the festival is about “reshaping our ability to look death in the eye, and to have a relaxed way of talking about death.” In a secular age, she says, we don’t have ways of congregating to talk about important things like death. more…

The Southbank Centre, London’s art centre on the South Bank of the Thames, is holding a festival of death. The aim is “to look death in the eye…to confront mortality head-on through music, theatre, literature, and debate.” more…

JAMA  25 Jan 2012  Vol 307
373   Here’s the kind of study that’s all too rare in the medical literature: an important interventional trial that is not funded by pharma. The question is whether giving a proton pump inhibitor can improve outcomes in poorly controlled childhood asthma: a reasonable hypothesis to test, since a high proportion of such children have been shown to have asymptomatic acid reflux. This double-blind RCT recruited 306 children from 19 US centres, and shows that daily lansoprazole has no benefit and that it may have important harms. The active drug group had more respiratory infections and markedly more fractures (6 vs 1): not to the point of statistical significance, but definitely to the point of warranting an urgent database study of fracture incidence in children taking regular PPIs. more…

“Research highlights” is a weekly round-up of research papers appearing in the print BMJ. We start off with this week’s research questions, before providing more detail on some individual research papers and accompanying articles.

• Does treatment with GLP-1R agonists lead to weight loss in patients who are overweight or obese?
• Can vitamin A supplementation lower the risk of hearing loss in undernourished children?
• How effective is an adjuvanted monovalent vaccine against pandemic influenza A/H1N1 in people with underlying chronic diseases?
• Can a new algorithm estimate the absolute risk of having ovarian cancer in women with and without symptoms?

Improving diagnosis of ovarian cancer in primary care
Early diagnosis of ovarian cancer improves prognosis: five year survival among women diagnosed with stage I ovarian cancer is 90%, compared with only 20% for stage III cancer and 6% for stage IV. Currently, however, less than 30% of women are diagnosed with stage I cancer, as the disease has few established risk factors and a range of non-specific symptoms such as loss of appetite, weight loss, and abdominal pain that also occur with less serious and more common conditions. more…

It’s worrying  that the quest to evaluate the evidence underpinning major public health decisions feels like a game of chess—how do you try to anticipate the next move of your opponent and how might they bide their time to stay in the game.

And so the next instalment of what can only be dubbed the “Tamiflu saga” has unfolded. Roche has finally responded to questions that the BMJ put to them last year during an investigation which was conducted alongside a Cochrane review of the data on Tamiflu in healthy adults and published last week. more…

The Lancet, the leading journal for global health, has mentioned feminism only twice in its 189 years . The BMJ hasn’t mentioned it at all. So that looks like some evidence that feminism has had no impact on global health, but all three speakers at a meeting at the London School of Hygiene and Tropical Medicine this week strongly disagreed.

(Ironically this paragraph illustrates the superiority of women over men. Richard Horton, editor of the Lancet and a man, told us that the Lancet had mentioned feminism only twice, and Tony Delamothe, deputy editor of the BMJ and another man, told me that the BMJ had no entries. I, a third man, didn’t check, but Jane Smith, another deputy editor of the BMJ and a woman, did. She found that the BMJ has had 102 mentions of “feminism” and 302 mentions of “feminist” and the Lancet has 23 mentions mentions of “feminism” but none of “feminist.” Thank God for women.)

One reason that the journals might not have mentioned it is because “feminism” is a taboo word within academic medicine, said Richard Horton, editor of the Lancet. Lori Heise, one of the speakers and a senior lecturer at the London School, said how she had to think carefully before “coming out” as a feminist. more…

The period between Christmas and 1 January is a quiet one for UK news outlets. The government and most major organisations hold back big announcements until the new year; and if there are no breaking stories about murders, natural disasters, or wars, filling those (albeit diminished) news pages and television and radio bulletins can be difficult.

Working on the BMJ’s news desk at this time, I did what most journalists do when searching for stories: I looked at what everyone else had written. I found stories with shady sources; wild claims with no figures to back them up; and rehashed Department of Health announcements. There was nothing here to exercise Lord Leveson’s inquiry into media ethics, but the coverage was interesting nevertheless. more…