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Ahmed Rashid: “Physics envy” in evidence based medicine

16 Sep, 14 | by BMJ

ahmed_rashidResearchers have long debated the relative complexity and importance of different scientific disciplines.

Traditionally, sciences that used the most mathematical equations—such as physics—were deemed the most intellectual and placed at the top of an academic hierarchy, while social sciences were consigned to the lowest point.

Willard Van Orman Quine, who held the Edgar Pierce chair of philosophy at Harvard University for over two decades, famously exemplified this belief in 1981: “Physics investigates the essential nature of the world, and biology describes a local bump. Psychology, human psychology, describes a bump on the bump.” more…

Ian Bushfield: Respond to EMA and FDA consultations

12 Sep, 14 | by BMJ

On Monday 15 September, two important consultations (one by the EMA and one by the FDA) will close, ending the public’s opportunity to respond to these consultations and help defend the independent analyses of medical data. The AllTrials campaign has been urging interested parties to respond and have their say on these two consultations, which are outlined below.

Tell the EMA not to censor independent analyses

In Europe, the medicines regulator wants the right to censor analyses of side effects data that it disagrees with. The European Medicines Agency (EMA) is consulting on updates to its EudraVigilance access policy. EudraVigilance is the database where reports of side effects from approved drugs in Europe are recorded. The proposal would give researchers access to more detailed and systematic records from the database, but it also contains a condition that would give the EMA the ability to block publication of analyses it disagreed with. more…

Dawn Richards: A Canadian arthritis patient charter

9 Sep, 14 | by BMJ

Dawn-Richards_newIn 2014 the Canadian Arthritis Patient Alliance (CAPA) undertook the creation of an Arthritis Patient Charter. The arthritis community in Canada has a history of collaboration, to which this project was no exception. In 2001 the creation of an Arthritis Patient Bill of Rights (English and French versions) was led by the Arthritis Society with input from all stakeholders and which was more advocacy-based document (it came out at the time when patients were lobbying for access to biologic treatments). In the nearly decade and a half since that bill was produced, we felt that it was time to provide new life to this document.

more…

Roy K Philip: New “Kerala model” on alcohol policy: Great public health initiative or an “alco-pops” repeat?

8 Sep, 14 | by BMJ

Roy_K_Philip
The Indian state of Kerala has the highest alcohol consumption per head in India (8.3 litres against the national average of 4 litres,[1] while also being credited with the highest literacy rate (including female literacy),[2] best social indicators, and best infant mortality.[3] Kerala has the historical mix of influences from the spice trade, its early introduction to Christianity and the English language, tea and rubber plantations, the first elected Communist government of the world, and, during the past three decades or so, the economic affluence resulting from the millions of Keralites choosing to work abroad—particularly in the wealthy Gulf region. more…

Ohad Oren: Why soldiers are like patients

29 Aug, 14 | by BMJ

 

Credit: Herbert Bishko

Credit: Herbert Bishko

Each war revives the clash between the safety of a country’s own citizens and that of its soldiers. The recent Operation Protective Edge, taken by Israel with the objective of restoring calm to its citizens, should be examined by the same standard. Was the presumed political gain worth the soldiers’ loss of lives? Was the blow to Hamas’s infrastructure a reasonable compensation for the death of sixty four young combatants? And, more broadly, are we willing to sacrifice the innocent lives of soldiers in order to temporarily decrease the number of rockets targeting our neighborhoods? more…

Paul Teed: Is medical opinion shifting towards support for an assisted dying law?

27 Aug, 14 | by BMJ

Paul TeedOver the weekend, the Times published findings from a new survey conducted by Medix, which asked 600 doctors various questions on assisted dying, assisted suicide, and euthanasia. The coverage contrasted the findings with those from a similar Medix survey a decade ago, reported then in The BMJ. But reading the complete data in the new survey highlights what some would consider surprising, if not shocking, views from doctors, especially when we consider how the medical establishment is often cited as unanimously opposed to any proposals on this issue.

While the majority of doctors were against a UK change in law to allow physician assisted suicide and/or euthanasia when asked the question in broad terms, a majority of respondents also believed that there would be grounds for physician assisted euthanasia if a patient had a terminal illness. more…

Karen Sumpter: Can MRI help make inaccurate prostate cancer diagnosis a thing of the past?

29 Jul, 14 | by BMJ

Karen SumpterProstate cancer is the most common cancer in men; in the UK, it kills over 10 000 men every year, and currently there are over a quarter of a million men living with—and after—the disease.  If diagnosed early enough, prostate cancer can often be successfully treated. However, the diagnostic process is far from perfect, and it is arguably one of the most widely debated topics surrounding the disease today.

Firstly, the PSA test, which measures the total amount of prostate specific antigen in a man’s blood, can be inaccurate at detecting prostate cancer. A raised PSA level may indicate a problem with a man’s prostate, however, a high PSA level does not always mean the man has prostate cancer, and some men with prostate cancer may not have a raised PSA level at all. more…

Mayank Singh: The euthanasia debate in India

28 Jul, 14 | by BMJ

Mayank_singhThe case of Aruna Ramachandra Shanbaug was a landmark moment for the euthanasia debate in India. Aruna was a nurse working in the King Edward Memorial Hospital (KEM) in Mumbai. On the evening of 27 November 1973, Aruna was brutally raped. She survived, but asphyxiation had cut the blood and oxygen supply to parts of her brain, which resulted in her being in a permanent vegetative state (PVS) ever since. She cannot walk, eat, or even move, and relies on the services of the staff nurses of KEM who have, for more than 40 years, cared for and looked after Aruna. more…

Johanna Hanefeld and Richard Smith: Charging for non-EEA migrants’ access to the NHS—who will follow?

25 Jul, 14 | by BMJ

Johanna HanefeldThe UK government recently announced that it will in future charge migrants from outside the European Economic Area (EEA) and foreign visitors a 150% fee for service when using the NHS. This is to recoup the estimated costs incurred when patients from abroad use services without entitlement. Justification for the additional surcharge is to incentivise hospitals to implement this type of cost recovery.[1] more…

Bijal Chheda-Varma: Bariatric surgery is unsustainable

22 Jul, 14 | by BMJ

Bijal Chheda-Varma2Obesity is widely recognised as one of the greatest health threats of the 21st century across the developed world, with about a third of the global population now obese or overweight.

While the evidence of the problem is undisputed, there is little agreement as to how to solve it. Many solutions are being brandished about in terms of both prevention and cure; in the UK, for example, a sugar tax has been suggested, and NICE has issued its headline grabbing draft recommendations that patients with a BMI of 30 or more should be given bariatric surgery. From my experience of treating overweight and obese patients, it seems clear that, as standalone solutions, these are not sustainable as they do not address the root causes of obesity. more…

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