US healthcare costs are unsustainable and a large amount of money is being wasted on unnecessary treatment.  There was general agreement about these statements among the audience, speakers and panelists at the recent Avoiding Avoidable Care conference, held in Boston. The summit was organized by the Lown Cardiovascular Research Foundation, the New America Foundation, and co-hosted by the Institute of Medicine. more…

Dear consultant colleague,

The standard of consultant letters is very variable so we have decided to introduce a new proforma for consultant letters to GPs.

Patients attend many different outpatient departments and we intend to introduce a different proforma for every department in each of the hospitals to whom we refer. more…

What was Ann McPherson’s secret?  How did she manage to accomplish so much, but still remain a warm hearted person, who remembered birthdays, gave porridge to Jon Snow when he turned up for breakfast time meetings, and offered the keys of her house to friends needing somewhere to stay? more…

Back in February, the BMJ reported that a whole class of implant—in this case large diameter metal-on-metal total hip replacement—was allowed to enter the global market without any clinical studies to assess their safety and effectiveness. Hundreds of thousands of patients around the world may have been exposed to toxic metal ions released from the hips and the potential risks from this that have been known and well documented for decades. more…

The BMJ tends not to commission obituaries of non-doctors. I can understand why. The journal’s print obituary section is already awash with the lives of distinguished doctors from the UK and overseas. It would need to be a lot larger if coverage was extended to eminent nurses, former health ministers, academics, and campaigners, But if its policy was different, I would have liked to see a BMJ obituary of Lord Ashley of Stoke, who died last month aged 89. more…

I spent last Wednesday afternoon with seven 3-4 year olds from Levenhall nursery in Musselburgh, East Lothian, just outside Edinburgh. They were taking part in an immersive theatre production by the children’s theatre company Licketyspit. I have known the company’s director, Virginia Radcliffe, for 18 years, since we met at a post natal group soon after our first children were born. Virginia had told me about her latest production—LicketyLeap—a few months earlier. She was thrilled to get funding for the show from the £6.8m pot that Inspiring Scotland has set aside for its Early Years Early Action programme for 2012 and she is delivering the show to 800 nursery school children in north Edinburgh, East Lothian, and Drumchapel, Glasgow. It was when I asked Virginia for more details about the show that my ears really pricked up. Everything she told me resonated with the health inequalities agenda championed by Michael Marmot. His report in 2010 (BMJ 2010;340;c818)  highlighted how focusing on early child development can help to reduce health inequalities by empowering children, building their confidence and social and coping skills, and reducing challenging behaviour to help them progress at school and make their way through modern life. more…

This week I attended and participated in a panel discussion at the Council for Health Research and Development (COHRED)’s 14th Global Forum for Health Research in Cape Town, South Africa. Last year the Global Forum merged with COHRED, and this year’s forum has had a distinctly different focus from the thirteen previous meetings. Whereas in the past focus was on how to get aid efficiently from richer countries to poorer ones, this year’s forum focused on how to stimulate research and development for health in low and middle income countries (LMICs). As I walked into the conference venue I was greeted by a banner that read “Change, not just exchange.” This represents a rather radical shift in thinking, away from the delivery of aid in a vertical giver-receiver fashion and towards considering how to strengthen health systems and creating capacity for research, development, and innovation within poorer countries themselves. more…

It’s boom time in Ghana right now. The country’s economy soared by 14% in 2011 thanks to new oil receipts—earning it a listing as the world’s fastest growing economy. This prosperity is a mixed blessing say the locals. Rents in the capital city Accra are approaching London levels—$2000 a month for an apartment in a decent area—fuel prices have rocketed, and food is expensive. But in the baking heat of the capital city’s Independence Square yesterday I witness a bit of African history made possible by Ghana’s emerging confidence. more…

Tootling along in the car on holiday. Brain idling, half listening to the radio when, out of the middle of an Irish language programme, jumped Ernest Hart. A former editor of the BMJ in whose eponymously named room we often have editorial meetings. But, on Raidió na Gaeltachta?

A historian recalled the spinning and weaving industry in Gweedore, a small town in County Donegal in the north west of the country. Ernest Hart, and his wife Alice, first visited and witnessed the terrible poverty and destitution in 1872. They returned in 1883 when Alice, herself also a doctor, was pivotal in organising local women and promoting weaving and spinning to provide a sustainable industry that continues today as Donegal Tweed. A remarkable woman who triumphed over considerable resistance both from local landlords and established textile manufacturers. She showed Donegal crafts at Olympia in 1888 and at a huge Donegal pavilion at the World Trade Fair in Chicago in 1893, and helped generate interest in the industry throughout North America. more…

“The same standard of openness should apply to all (drug) trial data, whether sponsored by industry, investigator-initiated, or sponsored by public grant-giving bodies.” That’s the view of representatives from the European Medicines Agency and the regulatory bodies from France, the UK, and the Netherlands writing in PLoS Medicine.

Their statement comes as accompaniment to an article detailing the Cochrane Collaboration’s attempts to track down unpublished oseltamivir (Tamiflu) trial data after Roche, the drug’s manufacturer, promised to provide the full clinical studies. more…