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Anne Gulland: Mental health problems—a gender divide

19 Jun, 15 | by BMJ

Anne_GullandFeckless, hysterical, neurotic, sluttish: these are just some of the adjectives used to describe female patients suffering from psychological illness in the book Good General Practice, an investigation into general practice published in the mid 1950s. [1] The author was Stephen Taylor, an eminent GP and civil servant whose views were typical of an age when it was still thought that women were biologically more prone to mental ill health than men. more…

Athene Donald: Learning lessons from Tim Hunt

17 Jun, 15 | by BMJ

athene_donald_2015Many years after his Nobel Prize winning discoveries in cell cycle regulation, Tim Hunt made some inappropriate and indefensible comments. It seems like the whole world wants to discuss those comments. Or rather, it’s as if they want to demonise the man and forget the totality of his life.

Scientists are supposed to like evidence. We are not supposed to cherry pick data to fit a model that ties in with our beliefs, and I fear that some of the more extreme extrapolations that have been made—based on one data point of some off the cuff remarks, however offensive people have found them—do not stand up to scrutiny. If any good is to come out of this whole sorry episode, I hope it will be that people scrutinise their own behaviour in the light of the issues regarding the ongoing barriers, explicit and implicit, that women in medicine and science face. more…

Sioned Gwyn on sexism and women in medicine

17 Jun, 15 | by BMJ

sioned_gwynSir Tim Hunt, British biochemist and Nobel Laureate, had until recently enjoyed relative anonymity outside of scientific fields. Recently, at an international conference of science journalists in Seoul, he was invited to speak at a meeting for women in science and delivered as part of his speech an extraordinarily ill judged few sentences which have come to haunt him: “Let me tell you about my trouble with girls. Three things happen when they are in the lab. You fall in love with them, they fall in love with you, and when you criticise them, they cry.


Karsten Juhl Jørgensen: Why do five recent reports on breast screening reach conflicting conclusions?

17 Jun, 15 | by BMJ

karsten_juhl_jørgensenSince 2012, five collaborative efforts to quantify the benefits and harms of breast screening have been published. These are the UK Independent Review, the EUROSCREEN Working Group series (both 2012), the Swiss Medical Board report (2014), the updated IARC/WHO Handbook, and a report from the Research Council of Norway (both 2015). The approach to put together panel members to review the evidence, and the methods to do this, has varied considerably. So have estimates and recommendations. The Swiss report found that harms outweighed benefits and recommended clearly against the intervention, whereas the EUROSCREEN Working Group and the IARC/WHO panel found the opposite. The UK and Norwegian reports were somewhere in between, estimating that three and five women, respectively, are overdiagnosed for each woman who has her life extended. They recommended screening, but also recognized that the balance is delicate and the need for informed decisions.  more…

Neel Sharma: We need to improve feedback to medical students

11 Jun, 15 | by BMJ

The other day I made a point of observing the number of people walking whilst using their mobile phones. I am sure we have all made a similar observation of people staring down at their phones. The vast extent of the problem has even been characterised clinically as “text neck.” I recall the days of my teens when mobile phones either didn’t exist or were a luxury. I was allowed to use my parents’ mobile on a Saturday evening when meeting friends to watch a film or go for dinner. And now it seems that if we don’t exchange instant messages with each other or send several Emojis’ a day we are out of touch more…

John Moxham: Smoking still kills

10 Jun, 15 | by BMJ

John_MoxhamSmoking still kills. Today it will kill 200 people. [1] People will die from heart attacks, from cancers, from respiratory illnesses, and many other conditions. But smoking doesn’t just kill. For every person that dies today 20 more will live with their illnesses needing the care and support of the NHS, social care services, and their friends and families. [2]

This places a terrible burden on individuals, families, and communities and yet further strain on our already creaking NHS. As NHS England stated in the Five Year Forward View: “the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health” (their emphasis). [3] Reducing smoking is the value proposition for the NHS. It is cheap, effective and it saves lives and money at a rate few other healthcare activities can match. Yet the chancellor has just ordered a £200 million cut to local authority public health budgets. more…

Jean Riley: A carer’s perspective on personal health budgets

9 Jun, 15 | by BMJ

I am Jean Riley, the mother of a beautiful 26 year old daughter who has profound and complex needs.

When we adopted our daughter from an orphanage in Romania, we thought we were bringing her home to die between clean sheets, but she survived. She was 5 years old and weighed just 12lbs. She has multiple health needs including heart disease, liver disease, sight and hearing problems, deformed feet and what can only be described as post traumatic stress disorder, which manifests itself in extreme self injurious behavior. She could not sit up, walk, or crawl, and was very depressed. We later added autism and attachment disorder to the list of problems we would face in the future. more…

Kenneth Collins on patient attitudes to women doctors

8 Jun, 15 | by BMJ

kenneth_collinsHetty Ockrim qualified in medicine in 1943, and after a short spell as a general practitioner in a mining community in wartime Blantyre and some hospital experience in obstetrics, she entered general practice in a working class area of Glasgow in June 1946 in partnership with her husband. After she retired in 1989, she carried out an oral history project interviewing patients on their understanding of health issues and the changes in the delivery of care during her long career. more…

Adam Smith: The life and legacy of oncology PROMs

5 Jun, 15 | by BMJ

Adam_SmithSince the 1980s, patient reported outcomes measures (PROMs) have been incorporated in cancer clinical trials providing invaluable information about symptoms, functioning, and quality of life from the patients’ perspective. In 2009, the US Food and Drug Administration (FDA), issued industry guidance on the use of PROMs in product label claims [1]. The guidance stressed the importance of developing tools with stringent criteria. These may be problematical for legacy PROMs, i.e. those developed prior to the guidance [2-3]. The issue then is, if we need to replace older PROMs to comply with the FDA guidance, are we at risk of abandoning tools with over 20 years’ of post development validation? more…

Marika Davies: Virtual ethics—could 3D avatars help prepare doctors to deal with ethical dilemmas?

2 Jun, 15 | by BMJ

marika_daviesThe news that virtual reality is making a comeback is likely to meet with a mixed reception in the world of medical education. Concerns were recently raised that simulation should be used less in medical education, and that medical schools “have vastly overused and abused the technologies of the unreal.” But the use of immersive virtual reality (IVR) to enable students to experience “live” ethical dilemmas may prove difficult to resist for those involved in their teaching. more…

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