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Richard Smith

Richard Smith: Treating cardiovascular disease as well as we treat TB and HIV

22 Dec, 14 | by BMJ

richard_smith_2014Globally, about 70% of people diagnosed with tuberculosis and about 40% of those with HIV are treated, but less than 20% of those who have had heart attacks or strokes receive the treatments known to reduce further events substantially, said Anthony Rodgers at the Global Cardiovascular Clinical Trials Forum in Washington earlier this month.

Even in high income countries, less than 40% of cardiovascular patients receive recommended drugs long term. There is, said Rodgers, “enormous undertreatment.” more…

Richard Smith: What is RRI and was I the wrong Richard Smith?

25 Nov, 14 | by BMJ

richard_smith_2014“I’d like to introduce Richard Smith, who is professor of philosophy at Durham University, an expert on epistemology, and chair of several European committees, who will speak on conflict of interest.” These weren’t the exact words that introduced me at the European Union’s conference on SIS-RRI (Science in Society—Responsible Research and Innovation), but they were close. I started with, “I’m afraid you’ve got the wrong Richard Smith, but it’s easily done when there are 5000 of us in London and New York. I am luckily going to speak about conflict of interest.” more…

Richard Smith: No case for retracting Lancet’s Gaza letter

3 Nov, 14 | by BMJ

richard_smith_2014 In 1973 about 280 000 scientific articles were published, but there were no retractions.  When I became an editor in 1979, retractions were rare and of little interest to anybody. Now we have moved to a point when somebody passionately objects to an article in a scientific journal they call for it to be retracted. The BMJ earlier this year had a group spend weeks deciding whether a paper on statins should be retracted (it decided against, in case you can’t remember), and there have been repeated calls for the Lancet to retract An open letter for the people in Gaza published in July  There is no case for retracting the letter.

The open letter was published during the recent bombing of Gaza in July and August. The whole world, including many Israelis, were horrified by what was happening. The Lancet letter was signed by 24 authors, all of whom “have worked in and known the situation of Gaza for years.” These authors sympathised much more with the plight of the Palestinians in Gaza than with the Israelis experiencing rocket attacks and worried about suicide bombers emerging from Gaza, and their letter is highly emotional. more…

Richard Smith: Leapfrogging to universal health coverage

28 Oct, 14 | by BMJ

richard_smith_2014Low and middle income countries have the chance to create health systems that will perform much better than those in high income countries. Copying health systems that look increasingly unsustainable would not be wise. Instead, low and middle income countries can “leapfrog” to something better, and the World Economic Forum has a project to make that happen. I heard about it in New York last week.

A plot of health adjusted life expectancy against the health expenditure of individual countries shows a plateau in the late 1960s at an expenditure of about US$500 per head adjusted for purchasing power. Yet most high income countries are spending more than US$2500, with the US spending US$8000. To be blunt, these high expenditures don’t look like “value for money.” more…

Richard Smith: The joy of a hernia repair

14 Oct, 14 | by BMJ

richard_smith_2014I had a hernia repair recently, but the day turned out to be one of the pleasantest I’ve had in a long time. Can that really be true?

Oddly, I looked forward to the day. It was partly the thought of being “made whole,” partly it being a different day from the normal, and partly a chance to experience the NHS doing what it does well. more…

Richard Smith: A tobacco company CEO writes to his marketing department

8 Oct, 14 | by BMJ Group

richard_smith_2014Dear all,

I see a great opportunity for us. You won’t believe this, but I’m at a public health conference in Sousse in Tunisia. I’ve come with my twin brother, a professor of public health. I am, of course, incognito. My brother asked me—yes, asked me—to come. Despite what you might think, we agree on most things—but differ radically on tobacco. We are twins, our connection goes deep. He hoped that by getting me to come to this conference he might get me to change my views. Unfortunately for him—and we’ve discussed this—the effect has been the opposite: I see a huge chance to grow our business. more…

Richard Smith: Improving health through the community in Tunisia

3 Oct, 14 | by BMJ

richard_smith_2014Tunisia, like all low and middle income countries, is having to respond to non-communicable disease after making good progress in reducing infectious disease and improving child and maternal health. Premature deaths from cardiovascular disease increased there by 35% between 1990 and 2010; they increased by 112% in Egypt and by 61% in Saudi Arabia—but fell by 21% in the United States. How best Tunisia might respond was discussed recently at a meeting in Sousse, organised by the Department of Epidemiology, University Hospital Farhat Hached.

Tunisia doesn’t have to start with a blank sheet. High income countries have already experienced the transition from infectious to non-communicable disease, and the aspiration is that countries like Tunisia can learn from the successes of high income countries without having to repeat their mistakes. more…

Richard Smith: Using data to improve care and reduce waste in health systems

30 Sep, 14 | by BMJ

richard_smith_2014Annual expenditure on healthcare in the United States is currently $2.8 trillion, and about a third of it is wasted, says the Institute of Medicine. The sum wasted is about five times the GDP of Bangladesh, a country of 160 million people. This is waste on a spectacular scale, and reducing it while improving the quality of care is the main aim of the information technology developed by Optum, the services part of the UnitedHealth Group, said Richard Migliori, a former transplant surgeon and chief medical officer of the UnitedHealth Group. I don’t come to tell you what to do, said Migliori speaking last week to the Cambridge Health Network, but I hope to at least elicit your sympathy. more…

Richard Smith: Patients harmed by misdiagnosed preferences

25 Sep, 14 | by BMJ

richard_smith_2014Linda is 58 and has been diagnosed with breast cancer. She would have preferred not to have surgery but was convinced by her surgeon that it would be the best option. After her operation, the hospital contacted her to apologise as she had not had breast cancer. She’d been misdiagnosed. An inquiry, legal action, and compensation followed.

Susan is 78 and has also had breast cancer. She too did not want surgery but was told that it was the best treatment. Six weeks after her operation, she met a friend of the same age who had also had breast cancer. She had been treated with hormone therapy, having been told that she would probably die of something else before her breast cancer. Susan felt profound regret, but no action followed.

These two women have both been damaged by the health system, said Al Mulley, director of the Dartmouth Centre for Health Care Delivery Science, at a meeting at the Health Foundation last week. And, he said, misdiagnosis of preferences is everywhere. For example, three quarters of surgeons think that losing a breast is the main anxiety of women with breast cancer, but only 7% of women rank that as their main anxiety. more…

Richard Smith: Is it time to stop using the word poverty in Britain?

19 Sep, 14 | by BMJ

richard_smith_2014Is poverty yet another word that is so misunderstood we should stop using it—at least in Britain? John Lanchester, a friend of mine, argued so in the Observer. Can he possibly be right?

Lanchester doesn’t seem to be arguing that we should stop using the word poverty when we mean “absolute poverty.” When the Millennium Development Goals were set absolute poverty was defined as having to live on an income of less than $1 a day, but subsequently it was raised to $1.25. In 1980 half the world’s population lived below that line, now it’s a fifth—1.2 billion people. Few people, if anybody, would dispute that having to live on such an income is to live in poverty. Using this measure, Asia might be expected to eradicate poverty by 2030, but the Asian Development Bank has just argued that the rate should be $1.51, meaning that nearly 60% of the population of Bangladesh—a country I visit regularly—is living in poverty. more…

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