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The BMJ Today: Medicines have a new competitor—gamification

16 Sep, 14 | by BMJ

Gamification is a theory, not just a trend. It is the use of game mechanics to solve real world problems, and that includes those that originate in the body. If the word instils in you a sense of fear and dread—as it did in me—look no further than this Feature by Stephen Armstrong to feel confident about talking gamification with your colleagues.

Anxiety in children, adherence to cancer medication, physiotherapy exercises, Alzheimer’s disease, schizophrenia, and obesity have all been targeted with specially designed games. Gamification’s efficacy in medicine is largely unknown. But investment in research is growing. more…

Richard Lehman’s journal review—15 September 2014

15 Sep, 14 | by BMJ

richard_lehmanNEJM 11 September 2014 Vol 371
1016  Ticagrelor has had mixed fortunes since it was introduced as a new thienopyridine platelet aggregation inhibitor a few years ago. The PLATO trial left lingering doubts whether it is better than the much cheaper clopidogrel when used in acute coronary syndromes. Rather than attempting to resolve these, the latest trial (ATLANTIC) compares prehospital administration of ticagrelor with in-hospital administration in patients undergoing immediate percutaneous coronary intervention for ST-elevation myocardial infarction. There is no difference. The name ticagrelor keeps reminding me of Excelsior, in Henry Wadsworth Longfellow’s poem of that name:

THE SHADES of night were falling fast,
As through an Alpine village passed
A youth, who bore, ‘mid snow and ice,
A banner with the strange device,
Excelsior! more…

Roy K Philip: New “Kerala model” on alcohol policy: Great public health initiative or an “alco-pops” repeat?

8 Sep, 14 | by BMJ

The Indian state of Kerala has the highest alcohol consumption per head in India (8.3 litres against the national average of 4 litres,[1] while also being credited with the highest literacy rate (including female literacy),[2] best social indicators, and best infant mortality.[3] Kerala has the historical mix of influences from the spice trade, its early introduction to Christianity and the English language, tea and rubber plantations, the first elected Communist government of the world, and, during the past three decades or so, the economic affluence resulting from the millions of Keralites choosing to work abroad—particularly in the wealthy Gulf region. more…

Richard Lehman’s journal review—8 September 2014

8 Sep, 14 | by BMJ

richard_lehmanNEJM  4 Sep 2014  Vol 371
892    A terrific piece by Rita Redberg discusses sham controls in medical device trials. Whenever sham procedures are used in the control arms of such trials (or in surgical trials generally) they reveal a huge placebo effect. For example, renal denervation therapy produced huge sustained falls in recorded blood pressure in unblinded, uncontrolled trials in people with “resistant hypertension”. But when it was tested in a properly blinded trial using a sham control, it failed to detect enough difference to satisfy its primary end-point. She goes on to point out that percutaneous coronary intervention has never been tested against sham PCI. I’ve just learnt to my amazement that Darrel Francis at Imperial College is planning a trial to do just this in people with angina and single-vessel disease, and it’s still open to extra UK investigators on    more…

Veena Rao: India’s getting closer to a national programme to address malnutrition

5 Sep, 14 | by BMJ

There’s good news finally. India’s new government announced in its budget speech, presented by finance minister Arun Jaitley on July 10 2014, that: “A national programme in mission mode is urgently required to halt the deteriorating malnutrition situation in India, as present interventions are not adequate. A comprehensive strategy including detailed methodology, costing, time lines, and monitorable targets will be put in place within six months.” The ruling party’s election manifesto had indeed stated earlier that “extreme poverty and malnutrition will be treated as a national priority and will be addressed on mission mode.” There was a bit of a wait to see the promise converted into intent, but so it was. more…

Saurabh Jha: The sunnier side of India’s free market for medical imaging

4 Sep, 14 | by BMJ

Saurabh_JhaWhat would medical care be like in a genuine free market?

Nobel laureates in economics have opposing views. But does India have the answer? There, healthcare has a strong private sector: patients usually pay directly and the insurance industry is just emerging.

Milton Friedman believed that markets would work just fine in healthcare. Kenneth Arrow was not so optimistic. In his much cited opus, Arrow singled uncertainty as the key factor that distinguishes medical care from other goods and services. Uncertainty means that one doesn’t know when and how much healthcare one is going to need. Not quite the same as shopping for cereal. more…

The BMJ Today: Bladder cancer—things can only get better

4 Sep, 14 | by BMJ

sarah_paytonAs diseases go, bladder cancer has a pretty raw deal. It lacks the attention and research funding given to other urological cancers (I’m looking at you prostate cancer), and—perhaps most worryingly—it is the only one of the top 10 cancers in the UK for which survival is getting worse.

One particular problem is delayed diagnosis, which disproportionately affects women. Gross haematuria is the most common presenting symptom, and evidence indicates that women experience not only more, but also longer, delays in diagnosis owing to repeated misdiagnoses of urinary tract infection.

In terms of expediting diagnosis, new research reported in The BMJ this week highlights the importance of recognising that non-visible (or microscopic) haematuria can also be an early symptom of bladder cancer. more…

The BMJ Today: Debating transparency, in research and practice

3 Sep, 14 | by BMJ

peter_doshiThe UK Faculty of Pharmaceutical Medicine lent its support for greater transparency in clinical trials, according to a News article on

President of the faculty Keith Bragman said, “We have a responsibility to patients.” The announcement came alongside publication of a survey of nearly 400 of its members, of which nearly two thirds reported working in the biomedical industry.

The faculty’s support for data transparency should perhaps come as little surprise. It had already signed the AllTrials petition last year. But, while it is tempting to celebrate another prominent institution voicing its support for transparency, the truth is that there are very few actors out there advocating for less (rather than more) transparency. Academic, industry, non-governmental organizations and governments alike are all emphatic when they tell us that clinical trial transparency is the right thing to do. more…

Richard Lehman’s journal review—1 September 2014

1 Sep, 14 | by BMJ

richard_lehmanNEJM 21-28 August 2014 Vol 371
711  I have a new little grandson called Timothy. He is lucky being born in August because respiratory syncytial virus generally lies low at this time of the year. Most babies get RSV at some stage of their first year, and the earlier they get it the worse it tends to be, with recurring bronchiolitis every time they get any kind of upper respiratory virus. So I’m hoping Tim won’t get RSV this side of Christmas, and that when he does he will shake it off as a mere cold. There is no effective treatment, although the NEJM seems to believe there may be one in the offing, as they have chosen to give space to a British phase 1 study of GS-5806, a novel oral small molecule that inhibits RSV entry at low nanomolar concentrations by blocking viral-envelope fusion with the host-cell membrane. That sounds like a pretty cunning trick, and in a challenge study in 54 healthy adults, it reduced the viral load and the severity of clinical disease. It also tended to reduce their neutrophil counts and raise their alanine aminotransferase. So not much use for my tiny Tim until it has undergone phase 2 and 3 trials in lots of adults and babies in the community. more…

The BMJ Today: When money and medicine mix

28 Aug, 14 | by BMJ

Anne_GullandEarlier this year, The BMJ published an editorial urging doctors in India to fight back against corruption in medicine. Kickbacks and bribes are a global problem but India, “with rampant corruption at all levels, is prominent in this international field,” the authors wrote.

Since the publication of the editorial in June, the article has been accessed more than 5000 times, but a new feature on by Vidya Krishnan shows how the anticorruption movement is gaining momentum. more…

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