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Richard Smith

Richard Smith: Time for a drive to register all global births and deaths

12 May, 15 | by BMJ

richard_smith_2014If your birth is not registered then you don’t exist, and yet a third of global births are not registered. If your death is not registered then your wife (or husband) may have poisoned you and not been caught, but two thirds of global deaths are not registered. Registration of births and deaths also allows the generation of health statistics and matters for education, human rights, justice, equality, and security. Yet civil registration and vital statistics (CRVS in the jargon) is poor in most low and middle income countries and sometimes weak in high income countries, a meeting organised by the Lancet was told this week. The Lancet also published a collection of articles on the subject, a follow up to its 2007 collectionmore…

Richard Smith: Keeping the NHS alive

6 May, 15 | by BMJ

richard_smith_2014The NHS has to change radically if it is to survive. All those who study the NHS closely know that, but I’m not sure that all those who work in the NHS know it. And the necessity for radical change—as opposed to more money—features hardly at all in our depressingly shallow election. But how do you change radically such a monolith, something so loved that every criticism can feel hurtful, and a service soaked in ideology? The current answer is “from the bottom not the top.” more…

Richard Smith: Australians fire an editor of the MJA for the fourth time

5 May, 15 | by BMJ

richard_smith_2014The Australian Medical Publishing Company (AMPCo), a creature of the Australian Medical Association, has just fired another editor of the Medical Journal Australia; that’s at least four (and probably more) in my professional lifetime. Over the same period the Canadian Medical Association has got rid of two, and the American Medical Association one. The British Medical Association has never fired one, although it’s come close.

Stephen Leeder, a friend of mine, was fired because he disagreed with AMPCo outsourcing production of the journal to Elsevier, the world’s largest scientific publisher and owners of the Lancet. Leeder is a former dean of Sydney University Medical School and one of Australia’s best known clinician scientists. Deputy editor Tania Janusic is also reported to have resigned along with several members, even most, of the editorial board. more…

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…

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