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Guest bloggers

Sean Roche: Resistance—what society needs to learn from the microbes

9 Jul, 14 | by BMJ

sean_rocheThe first week in July saw extensive media coverage of the looming specter of microbial antibiotic resistance. The basic problem: Big Pharma isn’t developing new antibiotics. We look on, seemingly helpless, in the face of ever evolving strains of dangerous, resistant “superbugs.”

The logic of this scenario is familiar, and mirrors perfectly our apparent helplessness in the wake of the slow motion unfolding of the planet’s ecological collapse. We know that fossil fuels are toxic for the environment, and yet Big Oil continues its voracious extraction, unabated, as the climate warms year on year. more…

Robin Kincaid: Surgical skills in Palestine—handing over the baton

7 Jul, 14 | by BMJ

robin_kincaidIn April this year, the Royal College of Surgeons of Edinburgh (RCSEd) team travelled to East Jerusalem to oversee the teaching of the Basic Surgical Skills (BSS) course, which has been endorsed by the Edinburgh college for Palestinian surgeons in training. The idea for this project grew its roots back in early 2010, and the scheme is now in its fourth year.

The team consisted of David Sedgwick (course convenor), Ruth McKee, John Anderson, Ian Wallace, Sarah Sholl, Magdalena Kincaid, and myself (Robin Kincaid). Once more, we had the invaluable help of the members of Juzoor Foundation, lead by Dina Nasser, and logistical support on the ground from the United Nations Relief and Works Agency (UNRWA), lead by Umaiyeh Khammash. more…

Gillian Turner: Recognising frailty in older people

18 Jun, 14 | by BMJ

gillian_turnerGiven the current emphasis on emergency admissions and older people, it is perhaps not surprising that the words “frail” and “frailty” are used almost interchangeably with “older people.” Yet more than 50% of people over the age of 85 will not have frailty. For the 40 to 50 % that do, we need to carefully consider how health and social care can best be of service.

But firstly, it is important to know what is meant by frailty. In short, it’s a loss of physical and psychological reserves, which means an increased vulnerability to minor stressor events. In other words, the outcome of an apparently small change in health—such as a minor infection or the introduction of a new drug—can be disproportionately poor. This could mean never getting back to a pre-existing state of health or independence, which then leads to a move to a care home or even death. more…

Liz Allen: The economic case for medical research

17 Jun, 14 | by BMJ

Liz_AllenFormer US president Bill Clinton achieved a lot in the White House. He presided over the longest period of peacetime economic growth in American history, he signed the North American Free Trade Agreement, and he was the first Democrat since Franklin D Roosevelt to win re-election. Yet when asked last month to recall his greatest accomplishment, he chose none of these things. The best thing he did as president, he told the Inclusive Capital Conference in London this year, was spending $3bn (£1.8bn; €2.2bn) on the human genome project.

The pride of place that Clinton gives to the sequence of humanity’s genetic code derives in large part from the way it has already contributed to great advances in treating cancer and rare inherited conditions, and the promise of personalised medicine. Its contribution to health, however, was not the reason he gave. He was proudest of the project’s role in generating an entirely new industry, which has become a fresh source of economic growth. That $3bn investment, by governments and charities, has brought a vast return—more than $180bn, Clinton said, is now invested in genome companies in the US alone. more…

Tom Jefferson and Peter Doshi: EMA’s double U-turn on its Peeping Tom policy for data release

13 Jun, 14 | by BMJ

Yesterday’s announcement that the EMA Management Board may have adopted a less obstructive policy to releasing clinical trial data comes hard on the heels of widespread coverage (see here, here, here, and here) and protests (by the EU Ombudsman, us, us again, Trudo Lemmens, the ISDB/AIM/ Nordic Cochrane Centre/ Medicines in Europe Forum, German IQWiG, and AllTrials). All this, plus a Twitter #screenonly campaign, reveals enormous discontent with the agency’s last minute announcement of “view on screen only” access to clinical study reports (CSRs), new “redaction principles,” and new legal “terms of use.”

In two responses, EMA executive director Guido Rasi defended the agency’s draft policy, explaining that the EMA’s latest draft policy represented “absolutely no change in direction.” more…

James Partridge: The face of a warrior for the human spirit

13 Jun, 14 | by BMJ

James PartridgeTo be chosen as the subject of the first People’s Portrait was, as Simon Weston put it, a very humbling experience. But as he showed consistently throughout the beautifully crafted BBC film about the making of the portrait, he is a delightfully humble man.

But not in the way you might imagine I mean. Not passive or unctuous as in the mode of Dickens’ Uriah Heap. No. A strong humble. A servant with such a great commitment to helping people, inspiring people by his remarkable courage and frankness. He is not the classical hero figure rising up and charging towards a huge goal of his own imagining. more…

Zoe Smith: Changing the story for neglected tropical diseases

11 Jun, 14 | by BMJ

zoe_smithWhile it’s been challenging to make neglected tropical diseases (NTDs) a priority on the global health agenda, until recently, the struggle to raise the conversation beyond niche circles has been even harder.

The illnesses are prevalent in places that many would struggle to find on a map, let alone pronounce (echinococcosis and onchocerciasis, for example). Factors like these make NTDs a challenging story to sell, especially as they mainly affect the world’s poorest (around 1.4 billion people).

Despite this challenge, at Development Progress, an Overseas Development Institute project, we have been working to highlight the drivers of progress in tackling NTDs, as these diseases have wide cross-sectoral links and effects, as well as an impact on almost all of the Millennium Development Goals (MDGs). more…

Chris Hopson: You get what you pay for—a different approach to the 2015/16 NHS tariff is crucial

10 Jun, 14 | by BMJ

chris_hopsonIf you get what you pay for, then 2015/16 risks being a very difficult year for the NHS, as the system affordability challenge, according to Monitor, jumps from 3.1% to 6.6%. This is driven by increasing demand and costs, a flat NHS budget, changes to NHS pension arrangements, and the *Better Care Fund.

NHS providers are also contending with pressure on NHS England’s specialist commissioning budget, which was overspent by more than £800 million last year (of which over £400 million was covered by the use of non recurrent and contingency reserves), but which is a key source of income for many trusts. And, on top of this, NHS providers are also faced with unfunded demands for mandatory service improvements, such as seven day services and increased staffing ratios. more…

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…

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