Recently I had the privilege of talking with the members of an emerging clinical commissioning group (CCG). (For those who don’t know, CCGs are groups of GPs who will have responsibility for commissioning care for a whole population.) It was my job to try and lift the conversation above governance, finance, and the future of the local hospital. I laid out an agenda of carbon reduction, polypathology, disruptive innovation, and, my favourite, death. And it was death that got them going, so much so that eventually you had to shout to be heard. (This was over dinner, and alcohol was served.) more…

JAMA  22 Feb 2012  Vol 307
813    When an Italian team of physicists reported that they had detected neutrinos travelling faster than light, the televisual physicist Jim Al-Khalili promised to eat his boxer shorts if it proved to be true. It turns out to have been a measurement error due to faulty wiring. Unbelievable results either shatter the laws of the known universe, or else they are wrong. So if a study tells us that 42% of women and 31% of men presenting with myocardial infarction do not have chest pain (or even pain in the arm or jaw), this either overturns clinical medicine as we know it – from experience and from several other large cohort studies – or else it is due to lousy recording. Guess which. This retrospective study is based on a single tick in a box completed by busy physicians looking after over a million patients coming into American hospitals with heart attacks between 1994 and 2006. It could be that they had better things to do than record the obvious. If these figures are true, then I will eat my elegant black Marks & Spencer long johns. These thermal underpants have proved very effective at protecting my lower parts from the ravages of winter on the eastern seaboard of America, and I just wish journal editors were as effective at protecting us against the ravages of bad data.
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