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Guest bloggers

Ahmed Rashid: Can we ever be “just friends” with big pharma?

6 Jun, 14 | by BMJ

ahmed_rashidIt’s been less than a decade since I started medical school and even in my short career the relationship between doctors and the drug industry has undergone drastic change. During undergraduate clinical placements, I spent many lunchtimes making polite conversation about a drug I had no interest in to justify scoffing the indulgent Waitrose sandwiches and chocolate brownies that the smiley rep had shrewdly chosen. My neatly ironed white coat was never without a pen, tourniquet, or tendon hammer stamped with a drug brand. Others went further and wore drug branded lanyards and stethoscopes around their necks. It was part of the look of the trendy junior doctors we emulated and nobody thought anything of it. I’m not sure people in their twenties are ever venerable enough to say “Oh, how things have changed!” but they really have. This is all but a distant memory now and rightly so. more…

Kevin Watkins: Universal health coverage—back on the global agenda

5 Jun, 14 | by BMJ

kevin_watkinsA few years ago, I was at a rural hospital in Eastern Province, Zambia. Doctors were trying frantically, and in the end unsuccessfully, to save the life of a five year old boy. He died from acute respiratory tract infection. But what really killed him, as one of the doctors told me afterwards, was poverty: his parents had been unable to afford the antibiotics that might have saved him.

Sometimes we lose sight of what’s at stake in the great debates on development—and nowhere more so than in health. Over the past few years, universal health coverage (UHC) has returned to the international agenda with a vengeance. Governments are making stirring commitments to deliver healthcare for all their citizens. Aid donors are promising to support their efforts. UHC has even made it to the shortlist for inclusion in the post 2015 Millennium Development Goals. more…

Gwyn Samuel Williams: “Les Miserables” examiners

5 Jun, 14 | by BMJ

gwyn_williamsI recently had the single pleasure of undergoing exit exams run by the Royal College of Ophthalmologists and could not help but wonder at how examiners could on the whole be easily categorised into certain subtypes which readers may find fascinating. This phenomenon has certainly has not been observed before in published world literature.

First, and certainly foremost, is the kindly empathetic Jean Valjean examiner. Shown kindness by others and helped along the way they are keen to repay their debt and help the younger generation by teaching and by lenient examination. “Who am I?” they ask themselves “to condemn this man to misery, pretend I do not feel his agony. This innocent who bears my face and goes to judgement in my place? When kindness was shown to me who am I to harass? What will I do? I will let him pass.” Unless serious errors are made then progress is assured and the debt of kindness is then perhaps passed on. more…

Simon Poole: NICE, statins, data, and doctors

4 Jun, 14 | by BMJ

simon_pooleIn June 2009, the World Health Organization declared the swine flu outbreak to be a pandemic. Most of us will recall the grave concerns expressed by politicians and the media about this potentially fatal illness. I remember at this time being called out late on a Friday evening to a patient suspected to have contracted the virus. With gown, gloves, and a mask on, I assessed the child, referred to the guidance based on previous recommendations from the National Institute for Health and Care Excellence (NICE), and wrote the first prescription for the precious antivirals that we believed were potentially lifesaving. So valuable were these medications perceived to be, that there was even talk of the possibility of their storage facilities requiring military security.

In April of this year, the Cochrane Collaboration published what many believe to be a damning review of the efficacy of these antivirals, claiming that a lack of access to available trial data had hampered the ability to verify the safety and effectiveness of these medications in 2009. The previous absence of this data was a gross betrayal of trust, and exposed physicians and patients to all the risks associated with prescribing a medication whose true value now appears to have been exaggerated. more…

David Berger: Stoushes, rorts, and cuts in Australian healthcare

3 Jun, 14 | by BMJ

david_bergerTo Europeans, Australia resembles the kind of alien planet so beloved of 1950s American science fiction writers. Strange, bounding animals hop across an arid, unfamiliar landscape, dotted with queer trees and even queerer, multi-coloured birds. The indigenous inhabitants of this planet called these birds “kookaburra,” although their meaning was allegedly misinterpreted when the colonists thought they also called the hopping animals “kangaroo.” The colonists speak a quaint form of English, and over time they have developed their own slightly drawling accent. They even have their own unique words to describe phenomena that seem to happen very frequently on this planet—words such as “stoush” (a bunfight or a punch-up) and “rort” (a swindle that involves gaming the system).

At the moment, there’s a major stoush about healthcare cuts going on between the prime minister, Tony Abbott, along with his Liberal National Coalition government, and, well, almost everyone else. The nature of this healthcare stoush is not entirely unlike any of the many stoushes that British doctors have been embroiled in over the years, as they have fought to defend publicly funded healthcare. more…

Florence Smith: NCDs and HIV—where’s the intersection?

30 May, 14 | by BMJ

florence_smithAt first glance, NCDs (non-communicable diseases) and HIV/AIDS seem to have little in common. However, a recent symposium, organised by the London School of Hygiene and Tropical Medicine and FHI360, showed that there is great scope for those working on these two big issues in global health to learn from each other.

HIV/AIDS has caused around 36 million deaths worldwide over the last three decades, but with new treatments mortality rates have dropped dramatically, and it now accounts for around 1.6 million deaths a year. NCDs kill just over 36 million people annually, with 80% of those deaths occurring in low and middle income countries. The World Health Organization has set a target to reduce deaths from NCDs, in those aged under 70, by 25% by 2025. more…

Liliana Gomes: How dirty is your QWERTY?

30 May, 14 | by BMJ

Liliana_GomesIt all started a few weeks ago in my communicable diseases module at the London School of Hygiene and Tropical Medicine. During a group brainstorming session we realised how “unclean” keyboards could be. Despite being a public health trainee, I had never thought carefully about how many harmful pathogens could live in a computer keyboard. We always think of how important it is to wash our hands before eating or after sneezing into them; however, when it comes to hand hygiene before or after using a multi-user computer, most of us really don’t care that much.

After doing some research into keyboards’ role in the development of infections, I soon realised that washing hands should be at the top of the list when using a public computer. Staphyloccocus aureus, Enterobacteriaceae such as Escherichia coli or Enterococcus faecalis, and antibiotic resistant Staphylococci (eg. MRSA) are just a sample of what you can find in a keyboard swab culture. Noroviruses, respiratory viruses (such as influenza), yeasts, and moulds can also be found. more…

David Zigmond: Is it time to renationalise the NHS?

30 May, 14 | by BMJ

david_zigmond2Recently the media has told us that the Labour Party is considering a long journeyed return: back to the nationalisation of rail services. Some claim that this will offer better long term value, efficiency, and safety.

Many would welcome this, but there is a puzzling anomaly: why do we not, instead, start with the NHS? For surely, the contentious market principles of competitive commissioning are better suited to human transport than human healthcare. This is an important distinction, and our failure to recognise the difference between the mechanical and the human has led to a new tranche of serious NHS problems. more…

Jane Feinmann: Is the current system of publishing clinical trials fit for purpose?

30 May, 14 | by BMJ

jane_feinmannThis question was the title of a meeting of the Medical Journalists’ Association last week, and, perhaps surprisingly for an audience made up almost exclusively of medical journalists, the response was a resounding no.

So what happened? Medical journals, the main vehicles for publishing clinical trials today, are after all the “gatekeepers of medical evidence”—as they are described in Bad Pharma, Ben Goldacre’s 2012 bestseller. They have a robust, evidence based reputation for usefulness: publishing research that translates scientific discoveries into practical applications—and that includes negative results. “In recent times, one in three trials published in The BMJ have been of a negative result,” Dr Trish Groves, deputy editor of The BMJ and editor in chief of BMJ Open, told the meeting. “If there is bias, it’s more likely to stem from the academics themselves who don’t submit negative research because they see it as dull.” more…

Jane Parry: How many cases will it take for policymakers to realize there is a HIV problem in Hong Kong?

28 May, 14 | by BMJ

jane_parry3Announcing the most recent HIV statistics for Hong Kong yesterday, the Department of Health’s Centre for Health Protection reported 154 new cases from January to March this year. In effect, almost every day two more people became infected with a preventable disease that requires lifelong adherence to a drug regimen in order to stay alive.

Hong Kong’s schools are failing to teach young people even the most basic facts about safe sex, let alone giving them a forum to safely discuss and learn about sexuality. This shows in the sexual practices of young people: research by local non-governmental organisation AIDS Concern last year, for example, found that among 121 young people aged 14 to 21, 40.5% did not use condoms while having sex. more…

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