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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…

Vijaya Nath: Medical engagement—change or die

21 Jul, 14 | by BMJ

vijaya_nathMore than a year since Robert Francis’s recommendations, and after reports by Don BerwickSir Bruce Keogh, and the new Care Quality Commission inspection regime, we are still being challenged to demonstrate that healthcare is first and foremost focused on the needs of the patient.

At the same time, there has been a call for the most expensive assets in healthcare—the doctors—to step up and engage in management and leadership. We use the right words when writing about medical engagement, but how do we move from rhetoric to reality and, more importantly, why should doctors embrace this responsibility? more…

Gitau Mburu: Why communities should care about WHO’s antiretroviral guidelines

16 Jul, 14 | by BMJ

gitau_mburu2014A year ago, the World Health Organization (WHO) issued revised and consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. These guidelines included a key recommendation to initiate HIV treatment earlier (at 500 CD4 cells/mm³ or less) in order to ensure that people with HIV live longer, healthier lives, and to substantially reduce the risk of HIV transmission. If implemented globally, earlier HIV treatment could avert an additional 3m deaths, and prevent 3.5m new HIV infections by 2025.

Getting people on to treatment earlier is now a moral and scientific necessity. However, we know that many communities around the world are already facing tremendous challenges in accessing HIV services. Therefore, reaching a greater number of people who will need treatment even earlier is going to be complex, and will require wholehearted buy in and engagement from affected populations. more…

Jack Johnson: My week as a medical journalist

14 Jul, 14 | by BMJ

jack_johnsonI arrived at the offices of The BMJ on Monday 7 July, expecting to spend the day at a desk reading scholarly articles, which I had little chance of making sense of. I am a sixth form student and spent a week at The BMJ on work experience. My previous encounter with work experience was at Dunn’s Bakery in Crouch End, north London, so I was already impressed as I walked through the reception area of BMA House, and through the courtyard with its fountain and gargoyles. The BMJ’s offices are pretty standard, but it was the world of medical journalism that I was plunged into that really surprised and engaged me. more…

Halima Khan: People powered health—one year on

11 Jul, 14 | by BMJ

Halima KhanWhat links a social prescription in Newcastle, a peer retreat in Lambeth, and a neighbourhood network in Leeds? Well, these were three of the six frontline teams in the People Powered Health programme, which finished last year after running for 18 months. The programme—supported by the charity Nesta, along with the Innovation Unit—supported these six health teams in England to test and scale collaborative approaches to supporting people with long term conditions.

The teams were diverse—from primary to secondary care and mental health to musculoskeletal problems—but they were united by their commitment to creating an approach to healthcare that was powered by the people who work within it, and with the people it’s there for.

So, what does people powered health look like in practice? more…

Jacky Davis: Without assisted dying there’s too many difficult deaths

10 Jul, 14 | by BMJ

JackyDavisLast year my sixty year old brother took his own life. When he was diagnosed with terminal renal cancer, he had just watched a close family member die a drawn out and undignified death from cancer. He was determined not to go through the same misery—to have some control over his death. In the absence of the option of assisted dying, he planned his suicide; but suicide is not as easy as some suggest, particularly in the end stages of illness and with others to consider.

Eventually, paraplegic and breathless from pulmonary disease, he sent his wife away overnight to visit her mother. When she came back she found him dead at the bottom of a flight of stairs, in a pool of blood and with a noose in his hand. The coroner didn’t know how he died or, more to the point, how long he might have been conscious after his undoubted suicide attempt. What we do know is he was desperate, and that he died alone while trying to kill himself. The legacy of sadness for those he left behind overwhelms all other memories of him. more…

Lavanya Malhotra: Sex education in India

9 Jul, 14 | by BMJ

Lavanya MalhotraThe website of India’s health minister, Harsh Vardhan, currently states: “So called ‘sex education’ to be banned. Yoga to be made compulsory.” The media has not been impressed, and controversy rages as health professionals and educators debate the merits of age appropriate sex education in schools.

Vardhan has since retracted his original statement, saying: “Crudity and graphic representation of culturally objectionable symbols as manifested in the UPA’s [United Progressive Alliance, a coalition of political parties which governed India for the past 10 years] so called sex education programme cannot be called sex education. Every education system must strive to have an ideal curriculum, and to that extent my stand is valid. Sex education builds societies free of gender discrimination, teenage pregnancy, HIV-AIDS proliferation, pornography addiction.” more…

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…

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