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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…

Nick Rose: Severe mental illness after a natural disaster—notes from the Typhoon Haiyan area of the Philippines

23 May, 14 | by BMJ

nick_rose_philippinesThe occurrence of severe mental illness doubles in the months following a mass disaster (1). But few international agencies provide the specialist help needed at this time. And too often in resource poor countries, where disasters tend to occur, local mental health services are either non-existent or completely overwhelmed. So, although basic medical care, psychological first aid, and even counselling services are usually provided by international aid organisations, survivors suffering from psychosis, severe depression, and bipolar disorder are rarely catered for. more…

Tom Jefferson et al: EMA’s data sharing policy—towards peeping tom based medicine?

22 May, 14 | by BMJ

Tom Jefferson and Peter Doshi are two of the guys who battled for four years to access clinical study reports on antivirals for influenza for their Cochrane review. Here they muse on the possible arrival of look-but-don’t-touch research. Trudo Lemmens is a law professor. He has been working on the promotion of data transparency for the last decade. Here he looks at some of the possible legal ramifications of the story.

In 2010 the world changed for those who, like us, do Cochrane reviews (TJ, PD) and try to promote public health oriented science (TJ, PD, TL). The European regulator, the European Medicines Agency (EMA), changed its policy on the public disclosure of clinical study reports of clinical trials and other documents in its holdings. This occurred in response to criticism by the European Ombudsman who had accepted the strong case made by the Nordic Cochrane Centre. more…

Kristy Kruithof and Mafalda Pardal: Are we entering a new era of cannabis regulation?

22 May, 14 | by BMJ

kristy_kruithofmafalda_pardalThroughout the world, cannabis legalisation advocates and opponents have been following the recent debates and developments in the United States (Colorado and Washington state) and Uruguay with great interest. Although international drug treaties prohibit the production, distribution, and possession of cannabis for non-medical and non-scientific purposes, several jurisdictions have implemented new laws and policies, including some that remove criminal penalties for possession of small doses of cannabis. Colorado, Washington state, and Uruguay are taking these changes a few steps further by fully legalising the commercial production and sale of cannabis. In other countries, non-commercial models of production and distribution have also been developed, albeit operating in a grey or illegal zone. more…

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