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Richard Smith

Richard Smith: What should a patient ask before entering a clinical trial?

21 Oct, 16 | by BMJ

richard_smith_2014“What,” a Finnish journalist asks me, “should a patient ask before entering a clinical trial?” That’s a good question, I think, as on my feet I try to answer the question. So here’s an attempt at an answer.

She asked me the question because I’d been saying that much that is published in medical journals is wrong, many trials are never published, and many trials are more for the benefit of drug companies than patients. more…

Richard Smith: Can the NHS ever manage to analyse data to improve patient care?

17 Oct, 16 | by BMJ

richard_smith_2014In order to improve patient outcomes the NHS badly needs to collect data on all that is happening, analyse it intelligently, and present the information to clinicians and managers in an understandable and actionable form. That was the central message from Keith McNeil, who recently became chief clinical information officer health and social care for the NHS, to the Cambridge Health Network last week.

Previously, he was a clinician for 30 years and chief executive of Addenbrooke’s. His message, as I cynically observed, was probably said 15 years ago (if not longer) but it hasn’t ever happened. more…

Richard Smith: Is flexible working good or bad for health?

13 Oct, 16 | by BMJ

richard_smith_2014Australia, like Britain, pushed hard for more flexible working in the labour market in the 80s, and all political parties and trade unions supported it because they assumed  that it would both boost productivity and give workers more control of their lives. More control, it was thought, would improve health. But is more flexible working good for health? Jane Dixon, a professor at the Australian National University and a member of the Work, Time, and Health Team, addressed this question at a C3 Collaborating for Health Breakfast seminar earlier this week. more…

Richard Smith: Epidemiology—big problems and an identity crisis

10 Oct, 16 | by BMJ

richard_smith_2014The Germans probably have a more precise word for it, but it’s close to schadenfreude as an outsider to watch a professional group agonise over who they are, whether they matter, whether their methods are adequate, and whether they are missing something important. I had this experience in Bristol last week as a gaggle of epidemiologists simultaneously celebrated the achievement of Shah Ebrahim and George Davey Smith in editing the International Journal of Epidemiology and are now retiring.

BMJ readers will, unlike many members of the public, know the word epidemiology and that it’s something to do with studying disease in populations.  Indeed, in some fashionable quarters it’s being called “population health sciences.” As such, you’d think that epidemiologists have nothing to worry about because gigantic problems are arriving now with bigger ones on the horizon. more…

Richard Smith: Finding meaning in life through neurosurgery

7 Oct, 16 | by BMJ

richard_smith_2014Paul Kalanithi, a neurosurgeon, wanted badly to understand life and its meaning, and he knew that to do so he would need to understand death. So when in his 30s he developed a cancer that he knew would kill him, he thought (and subsequently wrote): “Shouldn’t terminal illness, then, be the perfect gift to that young man who had wanted to understand death? What better way to understand it than to live it? But I’d had no idea how hard it would be, how much terrain I would have to explore, map, settle.”

In his highly acclaimed book When Breath Becomes Air published after his death he describes the terrain he explored, mapped, and settled. The book is an autobiography with the second half describing his experience of his illness; and his wife, Lucy Kalanithi, an internist, added a chapter on his death and the aftermath. His terminal illness may have been a perfect gift and it certainly adds impact and narrative to his book, but I was fascinated more by the first half. more…

Richard Smith: The challenge of high need, high cost patients

28 Sep, 16 | by BMJ

richard_smith_2014A challenge to all health systems is how best to manage “high need, high cost patients,” a term developed by the Commonwealth Fund. Its president, David Blumenthal, discussed the best response in last week’s annual health lecture of Imperial College’s Institute of Global Health Innovation.

The first reason for caring about such patients is that they could be our family members or even us one day. But the reason that means they get special attention is that they account for high costs more…

Richard Smith: Being creative in developing primary care

26 Sep, 16 | by BMJ

richard_smith_2014Primary care covers the whole population, but it’s underfunded and has increasing difficulty recruiting doctors; and there are worries about equity and the quality of care. This could be the NHS in Britain, but it’s the health system in Florianópolis, Brazil. The NHS can learn from the Brazilian experience, and Jorge Zepeda, a family physician and former director of primary care in Florianópolis, shared how the services have responded creatively to the pressures at a C3 breakfast seminar last week.

The development of primary care in Brazil

Brazil committed itself to universal health coverage soon after democracy was restored in 1988 after years of military rule. Recognising the importance of primary care, the country introduced more…

Richard Smith: Teaching children to make better health decisions

21 Sep, 16 | by BMJ

richard_smith_2014After 30 years of trying to teach clinicians, policymakers,  journalists, and patients the basic concepts of deciding if claims about health interventions are valid, Andy Oxman, one of the originators of evidence based medicine, decided that it’s tough to teach adults new ways of thinking because of all the baggage in our heads. So he and his colleagues in Norway and East Africa have turned their attention to children. A group of 20 health and education researchers, teachers, clinicians, publishers, designers, and creators of games from eight countries met last week in Bellagio, Italy, to discuss progress with the work and future plans. more…

Richard Smith: Mental health—has the tide finally turned?

14 Sep, 16 | by BMJ

richard_smith_2014When I spoke to this group four years ago about mental health services all was doom and gloom, but now I feel optimistic. This is how Paul Farmer, chief executive officer of MIND, began his talk this week to the Cambridge Health Network. Despite about three quarters of patients with mental health problems still not getting the full package of care that would help them, Farmer has grounds for optimism.

Public attitudes to mental health are changing, with more people talking about their problems and stigma falling. Realistic stories in the media are outnumbering “mad axeman on the loose” stories, and following changes in the public and media attitudes politicians have made commitments to improving mental health and increased funding. more…

Richard Smith: The “micro-macro problem” and the difficulty of using evidence to make policy

9 Sep, 16 | by BMJ

richard_smith_2014Doctors commonly complain that they consider evidence before they treat a patient, but politicians and policy makers don’t use the same rigour when making changes to health services. Indeed, Margaret McCartney—GP, BMJ columnist, and now stand up comedian—calls for this in her show at the Edinburgh Fringe Festival: “What do we want: evidence based policy making? When do we want it? After systematic review and independent cost-effectiveness analysis.” But McCartney and others (including me at times) are falling into a common philosophical trap, failing to recognise the “micro-macro problem.” more…

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