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Richard Smith

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…

Richard Smith: How humans might divide into a superclass and a useless class

7 Sep, 16 | by BMJ

richard_smith_2014Many people think Sapiens: A Brief History of Humankind by Yuval Noah Harari the single most important book they have read, and a nonagenarian friend said it made him see world in a new way. The book has been translated into 40 languages, but the commonest question Harari was asked in his interviews about the book was “What next?” His new book Homo Deus: A Brief History of Tomorrow is an attempt to answer that ultimately unanswerable question, and he talked about it in London last night in the first performance of a world tour. more…

Richard Smith: Making workplace health work after 40 years of failure

30 Aug, 16 | by BMJ

richard_smith_2014What is it that makes a company successful? Could it be strategy, leadership, funding, great products, luck, or something else? All of those things are secondary to the “essence” that make for a successful company—which is the habits of the employees—argued Andrew Sykes, an actuary who is the founder of a company called Habits at Work at a C3 Breakfast last week. C3 is a global charity that works to prevent non-communicable disease.

We tend to think of bad habits, but there are also good habits. Good habits mean that employees do the right actions over and over again. Habits, said Sykes, are like the gene code of the company, running through every action, and can be compared to compound interest, which may not seem important day to day but can over time grow an investment hugely. Sykes divides habits into habits that are related to work and pivotal habits that drive the life and work of us all. more…

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…

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