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Richard Smith

Richard Smith: Rethinking the publication of surgical innovations

8 Dec, 16 | by BMJ

richard_smith_2014A scandal in cardiothoracic research has led Martin Elliott, a cardiothoracic surgeon at Great Ormond Street, to conclude that current methods of publishing surgical innovations are not only inadequate but also shameful. In a Gresham lecture in London recently he presented proposals for improving the sharing of surgical innovations.

The scandal

The scandal, which is now known across the globe, concerns Paolo Macchiarini, a brilliant and charismatic but ultimately flawed cardiothoracic surgeon. Macchiarini has replaced diseased tracheas in a series of patients with plastic tracheas that are supposedly covered in the patients’ stem cells. Most of the patients have died, and a Belgian cardiothoracic surgeon has said that he’d rather face a firing squad than undergo Macchiarini’s operation—because it would be a quicker and less painful form of execution. more…

Richard Smith: Working to make cholera a disease of the past

23 Nov, 16 | by BMJ

richard_smith_2014Until last year the Cholera Hospital in Dhaka, Bangladesh, could have a thousand admissions a day before and after the monsoon. On a calm day now it still has hundreds. Not all the patients, many of them children, have cholera but many do. Many of the children also have malnutrition, sometimes severe. In order to cope the doctors used to have to erect a tent in the car park and fill it with cholera cots that were inches apart. A cholera cot has a hole in the middle to help management of the profuse diarrhoea that is the hallmark of cholera. As the tent was dark my immediate thought on entering the tent was of pictures of the Crimea with Florence Nightingale, the lady with the lamp, attending the dying soldiers. But few die in the Dhaka Cholera Hospital as the nurses and doctors are so adept at treating the disease, and tremendous improvements in the hospital mean that the tent hasn’t been needed in 2016.


Richard Smith: Why is the Mona Lisa the most famous painting in the world, and why are Facebook and Harry Potter so popular?

21 Nov, 16 | by BMJ

richard_smith_2014When you enter the room in the Louvre that contains the Mona Lisa you find people crowded around the bullet-proof case that contains the Mona Lisa and largely ignoring the other paintings in the room, which include other masterpieces by Leonardo da Vinci. Four-fifths of the people who visit the Louvre do so to visit the Mona Lisa, and its insurance value is £700m, way ahead of any other painting. Why is it the most famous painting in the world? And why are Facebook, Harry Potter novels, Shakespeare, and Katy Perry so popular? more…

Richard Smith: Death and the inescapable logic of greed

11 Nov, 16 | by BMJ

richard_smith_2014Martin Shkreli is the man who became infamous through buying the rights to Darapim (pyrethamine) and raising the price by 5000% from $13.50 to $750 per pill. There is, I suggest, an inescapable logic to his move that Hillary Clinton described as “outrageous.”

Pyrethamine has been around since 1959 and used, usually in combination, to treat toxoplasmosis and malaria. But now with the enthusiasm for “repurposing” drugs it is being tested or proposed as a treatment for motor neurone disease, chronic lymphocytic leukaemia, and melanoma. This is where the logic begins—because people will pay a great deal of money for a few more weeks of life or even the possibility of a few more weeks. more…

Richard Smith: The optimal peer review system?

8 Nov, 16 | by BMJ

richard_smith_2014Peer review is faith not evidence based, but most scientists believe in it as some people believe in the Loch Ness monster. Research into peer review has mostly failed to show benefit but has shown a substantial downside (slow, expensive, largely a lottery, wasteful of scientific time, fails to detect most errors, rejects the truly original, and doesn’t guard against fraud). Research has also failed to show that “improvements” such as training, blinding, opening up the process, or using checklists make much difference, but the peer review continues, and perhaps “real world evidence” can show us the optimal system.

Atmospheric Chemistry and Physics has “real world evidence” that suggests it might have the best peer review system around. more…

Richard Smith: Holbein’s Dance of Death—the perfect Christmas present

1 Nov, 16 | by BMJ

richard_smith_2014Hans Holbein produced his Dance of Death in Basle in 1526, mainly because he needed the money. Pictures of the dance of death were fashionable, featuring on the walls of cemeteries, and people wanted their own pictures. The pictures have been reproduced many times in many forms since then, and the latest version is a book by Penguin published this month. It makes a perfect Christmas present.

People in medieval Europe were intimate with death but wanted anyway to be reminded often of death and the brevity of earthly life. Everybody believed in God and the afterlife and knew that earthly life was a fleeting trial before the eternity of an afterlife. That afterlife might be spent in either heaven or hell, and being frequently reminded of death helped people concentrate on living a good life and so qualifying for heaven. Everybody—no matter whether king or peasant, physician or patient—danced with death throughout their lives, as we do now. Pictures of the dance of death emphasised the equality of all before death. more…

Richard Smith: STPs—too much sustainability, too little transformation?

26 Oct, 16 | by BMJ

richard_smith_2014STPs (Sustainability and Transformation Plans) are the device that it is hoped will save the NHS in England by dramatically improving efficiency and allowing NHS bodies to balance their budgets. They are being drawn up in the 44 “footprints” of England and are intended to cover acute hospitals, mental health, community services, and social care. Can they work or is there “too much sustainability and not enough transformation” was discussed at this week’s Cambridge Health Network meetingmore…

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…

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