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Richard Smith

Richard Smith: Doctors phishing for phools

29 Jul, 16 | by BMJ

richard_smith_2014In their influential book Phishing for Phools: The Economics of Manipulation and Deception two Nobel prize winners, George A Akerlof and Robert J Shiller, describe how businesses profit from exploiting human weakness. Politicians do the same and so, I suggest, do doctors.

(I was about to assume that all BMJ readers know about phishing, but then I thought I might be wrong. It is the fraudulent practice of sending emails that seem to come from reputable organisations asking you to send money, give your credit card details or passwords, or do other things that will exploit you. more…

Richard Smith: Journals, fraud, science, and misaligned incentives

25 Jul, 16 | by BMJ

richard_smith_2014Journals, like the mass media, have a major part to play in exposing scientific fraud and other kinds of misconduct. In contrast, as I’ve argued many times, there are better ways now to disseminate science. Yet sadly and ironically, exposing fraud is risky and expensive, whereas publishing science is often highly profitable. The incentives are all wrong. Can they be changed?

I’ve been prompted to write this blog after answering an email from a researcher who has spent many months trying to get an article published that exposes serious fraud. more…

Richard Smith: What are the causes of health?

19 Jul, 16 | by BMJ

richard_smith_2014Ask doctors for the causes of heart failure or any disease, and answers will pour from them. Ask them about the causes of health or wellbeing, and they will go blank. Doctors are trained to think about disease not health.

Sir Harry Burns, formerly chief medical officer for Scotland, asks doctors about the causes of health or wellbeing to get them thinking. He shows a slide, compiled by others, of the many theories of salutogenesis, the opposite of the familiar pathogenesis. They boil down, he believes, to just six things. They are: more…

Richard Smith: Why does prevention always come behind treatment of disease?

15 Jul, 16 | by BMJ

richard_smith_2014Why does prevention always come behind treatment of disease? Derek Yach, the chief health officer of Vitality, put this question to many people, and these are the answers he got from Don Berwick, formerly head of the Centers for Medicare and Medicaid Services and president of the Institute for Healthcare Improvement and a familiar figure around the NHS: prevention, answered Berwick, in contrast to healthcare lacks “a corporate voice”; and the science behind prevention is undeveloped.

The “corporate voice” of healthcare comes from hospitals, pharmaceutical and medical device companies, health insurers, health worker unions, and doctors and more…

Richard Smith: Another step towards the post-journal world

12 Jul, 16 | by BMJ

richard_smith_2014Recently I asked a leader of a major research funder what proportion of its grants led to a publication. “I’ve no idea,” he answered, “but it’s probably 20-30%. What bothers me the most is that it’s the positive stuff that gets published. You do an experiment day after day until it ‘works.’ You then publish what ‘works’ and not what doesn’t ‘work.’”

I was surprised that he wouldn’t know what proportion of grants led to a publication, that the proportion he guessed was so low, and that he knew there was a clear bias in what was published. Do research funders, especially those spending public money, not have an obligation to insist that all their grants result in some sort of publication (even if it’s simply an explanation of complete failure) and to avoid bias in what is published? more…

Richard Smith: Psychiatry in crisis?

4 Jul, 16 | by BMJ

richard_smith_2014Peter Gøtzsche, a Danish physician and researcher, has written a book arguing that 97% of psychiatric drugs cause more harm than good. Allen Frances, emeritus professor of psychiatry at Duke University and chair of the committee that produced DSM IV, says that 70% of Gøtzsche’s book is right but the big problem is that patients with serious psychiatric illness are being abandoned while many people with minor problems are overtreated. Both were speaking at a meeting in Leiden last week to celebrate 50 years of Geneesmiddelenbulletin, a journal that provides independent advice on prescribing.

The Dutch national organisation of psychiatrists boycotted the meeting and emailed their members saying they should not attend because the meeting was antipsychiatry, antiscience, and bad for patients. Yet there were some 40 Dutch psychiatrists in an audience of 400, and two of the speakers were Dutch psychiatrists. more…

Richard Smith: Transparency for better decisions—still a long way to go

23 Jun, 16 | by BMJ

richard_smith_2014We may like to think with websites that allow us to compare prices and get feedback on books, plays, and restaurants that transparency is empowering us, but is the balance of information fair? Do we know more about Google, Tesco, and the government than they know about us? Clearly not, and, argued Roger Taylor and Tim Kelsey, in a lecture this week to launch their book Transparency and the Open Society, transparency has great promise but we have a long way to go to reach a truly open society.

The authors define transparency as “the degree to which I can evidence whether or not I am being treated fairly.” more…

Richard Smith: On being misunderstood, exploited, and abused

20 Jun, 16 | by BMJ

richard_smith_2014A friend has pointed out to me that I am listed as an “exemplary professional” on the website of the Alliance for Human Research Protection. Others on the list include Florence Nightingale and the Nobel prize winner Sydney Brenner. I clearly don’t belong in such exalted company, but another on the list is Andrew Wakefield—yes, him of the fraudulent research that suggested that the MMR vaccine caused autism and created much suffering and confusion. It’s because of him—and the whole dubious nature of the website—that my friend wants me to protest.

I can see why I’m there. They have carefully and cleverly gathered together much that I have written over many years arguing that much of what appears in medical journals should not be believed. I am thus being used to advance their cause that research they don’t like should not be believed. I could be used in this way to advance almost any cause. more…

Richard Smith: What will the post journal world look like?

15 Jun, 16 | by BMJ

richard_smith_2014SMACCDUB is the conference of young critical care doctors, with a few mature ones thrown in for the mix, and the most energetic I’ve been to in a long time, perhaps ever. In a plenary session I sat on a white sofa drinking a 25 year old Irish whiskey next to Jeff Drazen, the editor of the New England Journal of Medicine. Our interaction was described by one Tweeter as a cage fight. There were six others on the sofas, them representing the future—and Jeff and I the past. more…

Richard Smith: Depression—a description of the near indescribable

6 Jun, 16 | by BMJ

richard_smith_2014I’ve never been depressed. I’ve been down, sad, blue, but never depressed. But many family and friends, people I love, have been depressed. Some have tried to describe it to me. I learnt about depression as a medical student, but I’ve felt my understanding to be shallow. I wanted to know more about this pernicious disease, something that strikes at a person’s soul in a way that cancer, TB, or any physical disease do not.

I made some progress when I heard the biologist Lewis Wolpert talk about his depression. It came in fast and left him in unutterable distress. What I remember from his talk was the extreme severity of his depression. The pain was so unbearable that only suicide was the answer, but he didn’t kill himself. His account, and various writings (including a BMJ personal view by the brother of a man who killed himself) made me realise that to die by suicide is exactly comparable to dying from leukaemia: the disease has killed. more…

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