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Richard Smith

Richard Smith: If Volkswagen staff can be criminally charged so should fraudulent scientists

28 Sep, 15 | by BMJ

richard_smith_2014A man who steals a milk bottle may face a criminal charge. In contrast, a scientist who invents data, defrauds funders, and publishes fabricated data that may lead to patient harm is highly unlikely to face criminal charges. The news that Volkswagen staff may be criminally prosecuted for manipulating emission tests raises again the question of whether scientific fraud should be a criminal offence.

I’ve blogged on this before, arguing that there are three main arguments for making scientific misconduct a criminal offence. Firstly, it’s no different from financial fraud, which is a criminal offence, in that resources (often public funds) are misused. Secondly, universities are poor at conducting investigations and gathering evidence, whereas it’s an everyday job for the police. Thirdly, universities and other employers of researchers face a painful conflict of interest in exposing one of their researchers as fraudulent and have often failed to properly investigate, punish, and put the record straight. more…

Richard Smith: Reading for a long life

24 Sep, 15 | by BMJ

richard_smith_2014At 63 I’m preparing for my capacities and faculties to fall away, and I think about what I hope to preserve. Taking being with those I love as a given, the most important things to me are in order: reading, writing, listening to music, walking, and looking at art. I also love theatre, food, wine, travel, and whisky (all the paraphernalia of a privileged, middle class, highly educated life), but these are of the second rank. So I hope that reading will be the last to go, and recently I’ve learnt (through reading) two new things: firstly, that my reading may prolong my life; and secondly, what makes a regular reader. more…

Richard Smith: How well are countries doing in responding to the NCD pandemic?

18 Sep, 15 | by BMJ

richard_smith_2014A pandemic of NCD (non-communicable disease) is sweeping across the world, particularly in poor countries, causing much suffering and premature death and swamping health systems. NCD (cardiovascular disease, diabetes, chronic obstructive pulmonary disease, and common cancers) accounts for 63% of global deaths (37 million annually), with 80% occurring in low and middle income countries. Almost a third of deaths from NCD in poor countries are in those under 60.

Recognising the scale of the problem and that deaths from NCD are expected to increase by 15% between 2010 and 2020, the United Nations held a high level meeting in 2011 and produced plans on how to reduce the growing burden from NCD. Afterwards the World Health Organization (WHO) set a range of targets, including reducing deaths from NCD in those under 70 by 25% by 2025. But how well are countries doing? more…

Richard Smith: Promoting compassion

14 Sep, 15 | by BMJ

richard_smith_2014Edinburgh University’s Global Health Academy has together with Stanford University created a Global Compassion Initiative, and, as I walked last week towards the launch of the initiative in one of Edinburgh’s most elegant houses I wondered exactly what compassion is. I wondered too whether you can teach and promote compassion. What I was sure about is that we could do with more of it in the NHS and the world. more…

Richard Smith: Disciplined for being human

8 Sep, 15 | by BMJ

richard_smith_2014“Doctors need to bring something of themselves to their patients, to make a personal connection, if medicine is to be a healing science,” writes an anonymous obituarist, somewhat portentously, at the end of an obituary of Oliver Sacks. But if you’re a nurse you might be disciplined for such a human healing action. more…

Richard Smith: The NHS needs existential psychotherapists

3 Sep, 15 | by BMJ


Existential psychotherapists help people with the existential, eternal, unsettling, and human problems of meaninglessness, isolation, and the terror of death. These are problems that are causing much suffering in Britain and yet do not respond to the drugs that are the standby of the NHS. That’s why the NHS needs existential psychotherapists. It may have some—but in disguise. more…

Richard Smith: How to fill the void of evidence for everyday practice?

11 Aug, 15 | by BMJ

richard_smith_2014Some even most (depending on how you measure it) of what doctors do lacks strong evidence. Even when evidence exists it often doesn’t seem to be relevant to doctors—because their patients or their circumstances are so different from those in the trials that produce the evidence. This is especially true in low and middle income countries as most evidence is produced in high income countries. Understandably doctors grew wary of evidence from trials and make decisions on other grounds, particularly their experience. The result is that patients may suffer from not receiving effective treatment or receiving treatments that do more harm than good. Could this sad state of affairs be improved? A group of clinicians, researchers, evidence buffs, policy makers, and odds and sods (me) met in Bellagio in Italy last week to think about how. Most were from Africa. more…

Richard Smith: Science and journalism threatened in the high court

30 Jul, 15 | by BMJ Group

richard_smith_2014I wrote this piece some six weeks ago after giving evidence in a libel case reported by The BMJ and published on 30 July 2015 . I’ve had to wait until the case was over to post the blog.

I’ve just finished giving evidence for a day and a half in the high court in Toronto. I enjoyed the experience, despite being cross examined for five hours. Fulfilling his duty, the barrister tried to discredit me and my evidence. I don’t think he succeeded, but it’s for the jury not me to decide. It’s a 15 year story that led to me being in court, and I want to share that story, describe my experience in court, and reflect on important implications for science and medicine. more…

Richard Smith: Making patient data available—the risks are easy to understand, the benefits opaque

21 Jul, 15 | by BMJ

richard_smith_2014“We seem to spend all our time talking about the downside of making patient data available and little about the upside,” said a frustrated researcher at last week’s Sowerby eHealth Symposium organised by Imperial College’s Institute of Global Health Innovation. The problem seems to be that the downside—somebody’s health records being made public—is horrible, concrete, and easy to understand, whereas the upside remains vague, aspirational, and largely opaque to the public. more…

Richard Smith: Do dreams have meaning? The great divide

6 Jul, 15 | by BMJ

richard_smith_2014The other night in a dream I saw my father, who died 11 years ago. He was very clear, recently shaved, with his hair combed and in full colour. He was perhaps 60, although he was 81 when he died. Smiling, he hugged the person beside me (I don’t know who that was), and then he hugged me. I enjoyed the hug. Did this mean anything? Do our dreams mean anything?

I’m fascinated that we don’t know the meaning of something we all experience. I often ask people what they make of dreams. The morning after the dream of my father, I had breakfast in Dhaka opposite an Argentinian scientist. I asked her if she believed that dreams had meaning. more…

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