I’m excited to have started at the Ola During Children’s Hospital in Freetown, after hearing so much about it from the Welbodi Partnership, the charity I’ll be working for over the next year.

On first impressions, things at the hospital look good.  There are freshly painted wards and uniformed nurses.  There are notices on the wall:  “Drugs for inpatients are now free” (thanks to a German charity).  The outpatient benches are lined with parents and kids, waiting to be called into three consulting rooms.  The observation ward is full of children, one loudly fighting off the advances of a nurse brandishing a cannula. more…

Having been sacked from his position as the chief UK government drugs advisor Professor David Nutt may today be reflecting on the precarious position of anyone who seeks to advise politicians on controversial matters. more…

If I asked a physiologist to show me where her conscience is, I’m fairly sure she’d not be able to.  Yet, it seems, a great many doctors appeal directly to their consciences, or at least wish to be free to do so.  This is a little strange.  If a patient says “God makes me do it” suspicions arise.  So why should a doctor be at liberty to appeal to something beyond the empirically demonstrable?  I work in “health law and ethics”, and see lauded the great march away from a “Bolamised” system, wherein clinical judgement counted (officially) for pretty much everything, and values that worked against such professional opinion could be subjugated in accordance with the maxim “Doctor knows best”. more…

Frank Wells, who is probably the UK’s first professional fraud buster, says he has “yet to meet a female research fraudster.” All the 26 cases of proven villainy he has dealt with have been men. That’s interesting, but not quite enough to fill a blog and perhaps says more about the sex ratio of senior UK researchers, at least in the past, than anything really interesting about research fraud. But, still, 0 out of 26 is pretty impressive (well done, girls!). more…

Last week I fell onto an outstretched hand and clinically had an obvious fracture on the ulnar side of my left wrist.  Interestingly, the very diligent nurse practitioner who examined me became fixated on my scaphoid - having pushed extraordinarily hard in the anatomical snuffbox and eliciting pain.  Scaphoid views were requested and no fracture seen.  I expressed concern that perhaps the fracture was elsewhere, but was promptly told: ‘chances can’t be taken with the scaphoid’.  I was bundled into a futura splint, given a photocopy of my notes, instructions to return ten days later and shown the door.  I couldn’t help but read the notes the minute I walked out of A+E.  F.R.O.M. (full range of movement) dutifully scribed (almost everywhere); surprised me as I couldn’t move it even slightly. more…

Medicine has always been a pretty one-way business. We know, they don’t. It is us that ask the questions, their bodies that slip under our knives. Patients of course have always had their own opinions, told their side of the story to families and friends in the pub, kept their own counsel around the factory gates and the water cooler. But mostly we have been ignorant whether they loved us or loathed us. more…

Last Wednesday was the launch of the Declaration on Mental Health Research. This initiative is aimed at drawing attention to the imbalance of resources devoted to research on mental illnesses as compared to other disabling conditions (see http://www.researchmentalhealth.org.uk/). Mental health problems account for 15% of disability and yet only receive 5% of the research resources, so we need to triple the investment from about £74m per year to £200m. I expect readers of this blog are thinking that we can’t afford it … but the economic, social and human costs of mental ill health is £100 billion a year and proper research into mental health could help to shrink this total, as well as improving the lives of individuals and their families. A recent report by the Academy of Medical Sciences also concluded that for every £1 we invest in mental health research we get back each year, in perpetuity, 37p. That means after three years it will have paid for itself. more…

Few people outside of Washington have heard of Olympia Snowe, the senator from Maine. But on Tuesday, she became the most important person in healthcare reform. Her vote in the Senate Finance Committee gave the Obama Administration its first bipartisan victory on healthcare. more…

After the blow to my confidence last week with obstetrics patients, I have developed a healthy fear of the uterus and have understandably been reluctant to see ante-natal, labouring, or post-natal patients.  Any organ that bleeds 500ml a minute is a thing to be feared in my book.  Of course the problem with my reluctance is that over 50% of what happens here has something to do with pregnancy, and again today we found ourselves without an obstetrician for both a delivery and also an ante-natal clinic.  Me, again? Oh no. more…

The inquest into the death of Kerrie Wooltorton in 2007 has focused some media attention on advance decisions (directives), or so-called ‘living wills’. While undoubtedly a tragic case, however, it is worth unpicking what we can actually learn from it. more…