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Richard Smith

Richard Smith: “Flat of the curve” healthcare

23 Mar, 15 | by BMJ

richard_smith_2014Alain Enthoven, an economist and inventor of the internal market, described “flat of the curve” healthcare where increased expenditure on healthcare produces no further benefit. Are we at that point in many health systems in high income countries, including Britain?

Enthoven’s graph is best thought of as theoretical insofar as it’s not easy to measure the total benefit from a health system, although economists have tried to do so. But we do know that plotting expenditure on healthcare against life expectancy for each country shows that once a country spends about US$600 per person on healthcare there is little improvement in life expectancy. Indeed, Cuba, which spends US$558 per person, has the same life expectancy (79) as the United States, which spends US$8895. more…

Richard Smith: Will health become more like education or education more like health in the UK?

13 Mar, 15 | by BMJ

richard_smith_2014Uwe Reinhardt, the world’s funniest health economist, says that eventually all health systems will be the same: whatever they want for the rich; an insurance based system for the majority; and a rump service for the poor. “Never in Britain,” say Reinhardt’s British friends, but I wondered if he might be right as I read David Kynaston’s compelling lecture on private schools in Britain. Will health become more like education or education more like health? Which way will Britain go? more…

Richard Smith: Why the faithless need to work with faith based organisations

4 Mar, 15 | by BMJ

richard_smith_2014Perhaps because Britain is a land of atheists, the British don’t understand the importance of faith based organisations as well as they should. Stephanie Ferguson, director of the International Council of Nurses’ Leadership for Change Programme and a member of the board of directors of the Catholic Medical Mission Board, urged the audience at the C3 breakfast seminar last week to reach out to faith based organisations.


Richard Smith: A global university for healthcare workers

24 Feb, 15 | by BMJ

richard_smith_2014WHO estimates that the world is short of 12.9 million healthcare workers, and Devi Shetty, the cardiac surgeon and chairman and founder of Narayana Hrudayalaya Hospitals, thinks that radical steps are needed to provide these workers. Money for healthcare for all will come, he believes, but it cannot be achieved unless healthcare workers are available to provide the care.

India, for example, needs three million doctors and six million nurses in addition to millions of community health workers. The country needs 500 new medical colleges, and Shetty is keen that the very poorest who have “magic in their fingers and passion in the hearts” should be able to train as doctors. more…

Richard Smith: Surgeons spend their time putting a price tag on human life

24 Feb, 15 | by BMJ

richard_smith_2014Physicians and surgeons across Asia, Africa, and Latin America spend their time putting a price tag on human life, said Devi Shetty, cardiac surgeon and chairman and founder of Narayana Hrudayalaya Hospitals, at the World Summit on Innovation in Heath in Doha last week. His mission is to reduce the costs of health to make healthcare available to as many people as possible. more…

Richard Smith: Writing an obituary of the living

23 Feb, 15 | by BMJ

richard_smith_2014Just as I think everybody should have a living will, a plan for their funeral, and clear instructions on whether you want to be buried or cremated, so I advise thinking about your obituary or even obituaries. If you are a doctor you can be sure to get one in The BMJ so long as somebody writes one, but you might fancy trying for the newspapers. You might write it yourself, but many publications are sniffy about self-written obituaries. So you might do better to get somebody to write one for you, and that’s why Sir Anthony Grabham rang me. more…

Richard Smith: Learning about alcohol problems from a taxi driver

16 Feb, 15 | by BMJ

richard_smith_2014When journalists arrive in a country at war their learning usually starts with taxi drivers. They see and hear a lot. They know the dark side of life, particularly those who drive at night. I learnt a lot from the taxi driver who picked me up at 5.45 this morning. I was his last job of the night.

He was well spoken for a taxi driver, and I learnt during our journey that his wife had a degree. He probably did too, but he’d been driving the taxi for 10 years, always nights. “I hate traffic,” he told me. The great advantage of his job is that he can have breakfast with his children every morning and then take them to school. Two “power naps” during the night plus two or three hours during the day are enough sleep for him. “Like Margaret Thatcher,” I said. more…

Richard Smith: Is the NHS being the top issue in the election a sign of a degenerate society?

2 Feb, 15 | by BMJ

richard_smith_2014Some polls suggest that the NHS is the number one issue for voters in Britain’s coming general election. That’s one reason that the Labour Party has put it at the centre of its campaign, the other being “when in doubt retreat to where you are comfortable.” But would a healthy society put the NHS as its top concern, or is this a sign of degeneracy? more…

Richard Smith: Loneliness—the “disease” that medicine has promoted but cannot help

27 Jan, 15 | by BMJ

richard_smith_2014According to the Canadian psychologist Ami Rokach who has long studied it, “acute loneliness is a terrorising pain, an agonising and frightening experience that leaves a person vulnerable, shaken, and often wounded.” In our world of anomie and divorce and where medicine has extended life beyond usefulness, loneliness is one of the main causes of suffering, and it’s a cause where medicine has nothing to offer. more…

Richard Smith: Would you like to die at 75 or 150?

16 Jan, 15 | by BMJ

richard_smith_2014“Sex and death are the only things that can interest a serious mind,” said W B Yeats, so, although more of a flippant than a serious mind, I return to death after my last pondering on the subject that spread literally across the globe. I’m asking whether it would be better to live to 75 or to 150, and if you know me at all you will know my answer.

I’m asking the question because a friend sent from America two interesting articles that address the question. more…

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