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Joseph Borick: A Jogini’s story

9 Oct, 14 | by BMJ

Joseph BorickOur story begins on a warm humid day in a rural village in Andhra Pradesh, India. Our team of six doctors, nurses, and medical students arrived with a mobile health bus to run a community clinic. As the patients rolled in and out of the clinic at a remarkably quick pace, I remember one patient* that immediately struck me. Her complaints of fatigue and weight loss with increased susceptibility to infections alarmed me. A brief physical showed diffuse swelling of her lymph nodes. With the help of a healthcare worker from Operation Mercy India Foundation, I was able to sit with this patient for an extended interview. Her story immediately gripped me. more…

The BMJ Today: Climate change and conflicts of interest: the sound and the fury

7 Oct, 14 | by BMJ

debs“Fury as top medical journal joins the green bandwagon” fumed the Daily Mail last week, which took exception to The BMJ’s publication of an article that, in the words of editor in chief Fiona Godlee, was not medicine or health but “pure climate science.”

“In this unequal battle with big business and political inertia we have a crucial card to play: the knowledge that much of what we need to do to tackle climate change will bring substantial benefits to health,” Godlee charged, adding that the World Health Organization should call a public health emergency.

And how prescient that comment was. Said fury came from Dr Benny Peiser of the Global Warming Policy Forum (GWPF), a think tank founded by former Chancellor Lord Lawson.

“The World Health Organization would become a global laughing stock if they were to follow the ridiculously over-the-top demands of a green alarmist editor. There is a real disconnect between what they are saying and the reality,” he was quoted as saying. more…

Richard Lehman’s journal review—6 October 2014

6 Oct, 14 | by BMJ

richard_lehmanNEJM 2 October 2014 Vol 371
1285  Here is a trial which had me taking my glasses off and scratching my bald patch. Why on earth should a drug company—in this case Boehringer Ingelheim— want to pay for a trial of taking patients OFF a drug? And why in particular should it want to take people with chronic obstructive pulmonary disease off inhaled steroids while keeping them on a long acting beta-adrenergic agent (LABA), when we know that LABAs increase mortality unless you take them with an inhaled steroid? The latest evidence for this came in JAMA a couple of weeks ago. more…

The BMJ Today: More on climate change

3 Oct, 14 | by BMJ

BirteEarlier this year, The BMJ’s editor in chief, Fiona Godlee, was one of 50 senior UK medical professionals to sign a letter in the Times newspaper about the health benefits of ending investment in fossil fuels, and diverting funds instead to alternative energy and more active forms of transport.

On 1 October 2014, The BMJ published an editorial, calling for the World Health Organization to declare a public health emergency. The BMJ has campaigned about climate change for years, and the reactions from our readers have been interesting—indeed, as Godlee writes, “When The BMJ started publishing articles on climate change, some readers told us to stick to our knitting.” more…

The BMJ Today: Conflicting interests

1 Oct, 14 | by BMJ

Anne_GullandAs politicians enjoy a glass or two of the hard stuff during this week’s Conservative Party conference, they may like to find time to read a BMJ research paper on the impact of minimum alcohol pricing, and reflect on government policy in this area.

Prime minister David Cameron has reneged on promises to impose minimum prices, preferring instead a ban on the sale of “below cost” drinks. This means that alcoholic drinks cannot be sold for less than the value of tax paid on them. However, the paper by Brennan and colleagues shows that minimum unit pricing in England would be 40 to 50 times more effective in tackling the problems caused by cheap alcohol than the government’s “below cost” policy. more…

Gavin Yamey et al: Our hunches on how to tackle humanitarian disasters can cause harm

1 Oct, 14 | by BMJ

It seemed, on the face of it, to make a lot of sense. It seemed intuitively the right thing to do.

When the Indian Ocean tsunami struck on 26 December 2004, psychologists flew in to encourage survivors to openly discuss their feelings in detail—a process known as “debriefing”—as a way of warding off post-traumatic stress disorder. Psychologists had a hunch that it must surely be good for survivors to talk openly about the crisis and the difficult emotions it had caused.

Except we now know, from systematic reviews, that at best debriefing is ineffective, and at worst, as seen in the highest quality studies with longest follow-ups, it is actually harmful and worsens psychological stress. more…

The BMJ Today: Thinking diagonally

30 Sep, 14 | by BMJ

will_Stahl-TimminsNational commitments to reducing global CO2 emissions are in the spotlight again after the recent United Nations talks.

Earlier this year, the Intergovernmental Panel on Climate Change (IPCC) published their strongest statements yet about the possible health impacts of global warming. These impacts include increased vulnerability to disease and injury through a variety of mechanisms, including: climate and weather variability; changing patterns of vector borne diseases; and changes to air quality. more…

Richard Lehman’s journal review—29 September 2014

29 Sep, 14 | by BMJ

richard_lehmanNEJM 25 September 2014 Vol 371
1189  This week we start with mepolizumab. Before we know it, we encounter losmapimod. Enough is enough. I think the World Health Organization should convene an extraordinary meeting of the International Nonproprietary Names Committee with the sole purpose of Stopping Silly Names. Medical practitioners are serious people and they should not be expected to trade in nonsense words. When humanized monoclonal antibodies were new and few, it might have made sense to end all their names in zumab, but now there are so many nobody can remember which is which. Mepolizumab is targeted against interleukin 5. The first of two trials in severe asthma with sputum eosinophilia shows that it allows a useful number of people to avoid the regular use of oral corticosteroids or to reduce their dose. In the 24 weeks of the trial, the rate of adverse effects was the same as placebo. more…

The BMJ Today: Death talk in India

29 Sep, 14 | by BMJ Group

deputy chair of MJA on stage (1)How viable is a system of “verbal autopsy” to determine future health policy in a country where most deaths occur outside hospitals, are not attended by doctors, and are not medically certified? Meera Kay finds out more about India’s recently completed Million Deaths Study and the training of non-medical field workers to record written narratives, from families or other reliable informants in the local language, which describe the events that preceded the death.

In a country which has around 110 million smokers, some of these deaths will be smoking related. Last month an expert panel recommended a nationwide ban on e-cigarettes, arguing that their safety has not yet been established. In the meantime, tobacco companies see a market in e-cigarettes to grow and earn huge profits in. more…

The BMJ Today: Beyond doing no harm, helping can get tough

26 Sep, 14 | by BMJ

kristina_fisterMedicine can do great things, but at today’s things look rather bleak. Nine out of 10 people who are transferred to hospital with cardiac arrest don’t survive to discharge. Some argue that most of these ambulance transfers should not happen at all; others disagree. It’s not about the cost, as Americans have calculated the savings would be less than 0.1% of what the health system loses owing to fraud. But transfer might harm. Do join the discussion, as did Robert H Trenkamp, who tells us better hospital care is possible for these patients and that not so many need to die.

Harm can also come from not including patients in medical decision making. When asked to single out one thing that has made the most difference in her field in her lifetime, Angela Coulter opts for the development of evidence based, patient decision aids. more…

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