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Richard Smith

Richard Smith: Loneliness—the “disease” that medicine has promoted but cannot help

27 Jan, 15 | by BMJ

richard_smith_2014According to the Canadian psychologist Ami Rokach who has long studied it, “acute loneliness is a terrorising pain, an agonising and frightening experience that leaves a person vulnerable, shaken, and often wounded.” In our world of anomie and divorce and where medicine has extended life beyond usefulness, loneliness is one of the main causes of suffering, and it’s a cause where medicine has nothing to offer. more…

Richard Smith: Would you like to die at 75 or 150?

16 Jan, 15 | by BMJ

richard_smith_2014“Sex and death are the only things that can interest a serious mind,” said W B Yeats, so, although more of a flippant than a serious mind, I return to death after my last pondering on the subject that spread literally across the globe. I’m asking whether it would be better to live to 75 or to 150, and if you know me at all you will know my answer.

I’m asking the question because a friend sent from America two interesting articles that address the question. more…

The death debate: a response from Richard Smith

5 Jan, 15 | by BMJ

richard_smith_2014I’m sorry that I’ve upset many people who have cancer or who have had a bad experience of somebody dying of cancer [see previous blog]. That wasn’t my intention. I was writing for The BMJ and so primarily for doctors. My main intention was to urge people to think much more about death and dying because I’m convinced that will be good for all of us and for our society.

I declined all interviews, but I want to clarify some points and respond to others. more…

Richard Smith: Dying of cancer is the best death

31 Dec, 14 | by BMJ

richard_smith_2014Luis Buñuel, filmmaker, surrealist, iconoclast, moralist, and revolutionary, thought a lot about death. “Sometimes,” he wrote in 1982, a year before he died at 83, “I think the quicker the better—like the death of my friend Max Aub, who died all of a sudden during a card game. But most of the time I prefer a slower death, one that’s expected, that will let me revisit my life for a last goodbye.”

How do you want to die? You must think about it. more…

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…

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