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Richard Smith

Richard Smith: In search of scandal in Scotland

23 Aug, 16 | by BMJ

richard_smith_2014I’m on my way to Dumfries to investigate the state of the NHS in that region, and the thought of the town is making me remember when I travelled there in 1974, 42 years ago, to investigate what I and a friend believed to be a scandal, a scandal of those times.

I was a co-editor of Synapse, the journal of Edinburgh medical students that we imaginatively and wittily renamed Prolapse and Perhaps. My co-editor, Peter Bloomfield (later a consultant cardiologist in Edinburgh), and I didn’t want the journal to be a “third division Lancet” filled with tedious articles rejected by other journals but rather a fearless, campaigning newspaper that spoke truth to the powers of Edinburgh medicine. We campaigned on issues like the poor quality of education we were receiving and the need for decent education on sex problems, and boldly we put the first “fuck” in the journal, which led to me being summoned by the professor of pathology for a wigging. more…

Richard Smith: Preparing to be demented

8 Aug, 16 | by BMJ

richard_smith_2014My mother who is 86 has had no short term memory for nine years. She’s been in a nursing home for three years. My grandmother was also demented and died in a nursing home. My mother was 22 when I was born, so perhaps my dementia is close. I need to prepare myself.

My mother and I had a letter published in The BMJ in 2005, supporting the case for assisted suicide in relation to dementia.


Richard Smith: What if everyone over 55 was offered a pill to prevent heart attacks and strokes?

4 Aug, 16 | by BMJ

richard_smith_2014The NHS, like other health systems, is facing huge financial pressure. Bold thinking is needed, and the King’s Fund, a British health think tank, has commissioned a series of articles asking authors to explore radical questions of “What if . . .” All of the articles can be accessed at The NHS if—essays on the future of health and care and this is one of them.

Cardiovascular disease accounts for just over a quarter of deaths (27%) in Britain and costs the economy £15 billion a year, £11 billion of which are the costs of healthcare. Each year 41 000 people die prematurely (under 75) from cardiovascular disease. We know how to prevent half, and possibly three quarters, of these deaths, but at the moment we are failing to do so. more…

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…

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