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Richard Smith

Richard Smith: Transparency for better decisions—still a long way to go

23 Jun, 16 | by BMJ

richard_smith_2014We may like to think with websites that allow us to compare prices and get feedback on books, plays, and restaurants that transparency is empowering us, but is the balance of information fair? Do we know more about Google, Tesco, and the government than they know about us? Clearly not, and, argued Roger Taylor and Tim Kelsey, in a lecture this week to launch their book Transparency and the Open Society, transparency has great promise but we have a long way to go to reach a truly open society.

The authors define transparency as “the degree to which I can evidence whether or not I am being treated fairly.” more…

Richard Smith: On being misunderstood, exploited, and abused

20 Jun, 16 | by BMJ

richard_smith_2014A friend has pointed out to me that I am listed as an “exemplary professional” on the website of the Alliance for Human Research Protection. Others on the list include Florence Nightingale and the Nobel prize winner Sydney Brenner. I clearly don’t belong in such exalted company, but another on the list is Andrew Wakefield—yes, him of the fraudulent research that suggested that the MMR vaccine caused autism and created much suffering and confusion. It’s because of him—and the whole dubious nature of the website—that my friend wants me to protest.

I can see why I’m there. They have carefully and cleverly gathered together much that I have written over many years arguing that much of what appears in medical journals should not be believed. I am thus being used to advance their cause that research they don’t like should not be believed. I could be used in this way to advance almost any cause. more…

Richard Smith: What will the post journal world look like?

15 Jun, 16 | by BMJ

richard_smith_2014SMACCDUB is the conference of young critical care doctors, with a few mature ones thrown in for the mix, and the most energetic I’ve been to in a long time, perhaps ever. In a plenary session I sat on a white sofa drinking a 25 year old Irish whiskey next to Jeff Drazen, the editor of the New England Journal of Medicine. Our interaction was described by one Tweeter as a cage fight. There were six others on the sofas, them representing the future—and Jeff and I the past. more…

Richard Smith: Depression—a description of the near indescribable

6 Jun, 16 | by BMJ

richard_smith_2014I’ve never been depressed. I’ve been down, sad, blue, but never depressed. But many family and friends, people I love, have been depressed. Some have tried to describe it to me. I learnt about depression as a medical student, but I’ve felt my understanding to be shallow. I wanted to know more about this pernicious disease, something that strikes at a person’s soul in a way that cancer, TB, or any physical disease do not.

I made some progress when I heard the biologist Lewis Wolpert talk about his depression. It came in fast and left him in unutterable distress. What I remember from his talk was the extreme severity of his depression. The pain was so unbearable that only suicide was the answer, but he didn’t kill himself. His account, and various writings (including a BMJ personal view by the brother of a man who killed himself) made me realise that to die by suicide is exactly comparable to dying from leukaemia: the disease has killed. more…

Richard Smith: Returning health to the people

19 May, 16 | by BMJ

richard_smith_2014For the first two million years of humans there were no doctors. People were born, flourished, became sick, suffered, and then died without doctors. Probably there were healers who danced, sang, rattled skulls, and used herbs but managed without microscopes and randomised trials. “Scientific doctors” appeared recently, and quickly—according to Ivan Illich, the critic of industrial society—“expropriated” health from the people. Now the Creating Health Collaborative wants to hand health back to the people. Can they possibly succeed? more…

Richard Smith: A foretaste of the end of the NHS

11 May, 16 | by BMJ

richard_smith_2014When the NHS began in 1948 dental care was free at the point of delivery, but charges appeared as early as 1951. My current experience with dental services gives me a foretaste of how the whole NHS may begin to crumble.

There is little left of one of my upper molars. My NHS dentist has filled it several times, telling me honestly that the filling has a 50% chance of surviving. The alternatives, he said, were some sort of complicated crowning or extraction. As my many sins do not include vanity (and anyway the tooth is not easily seen), I thought that extraction would be best; and I wish now that I hadn’t gone along with the third filling—but it’s always hard to go against a professional. more…

Richard Smith: Ugandan health—what should be the priorities?

4 May, 16 | by BMJ

richard_smith_2014Uganda, like all low income countries, has formidable health problems and limited resources. If you were the health minister in Uganda what would be your priorities? This question was in the back of my mind as I listened to the presentations at the Uganda Health Summit held in BMA House and organised by the Uganda Diaspora Health Foundation and supported by the BMJ, BMA, and others.

The challenges

Total fertility per woman in Uganda is 5.7, and so, as under 5 mortality fell from 187 per 1000 live births in 1990 to 55 in 2015, the population is growing by 3.2% a year. It is currently around 39 million with 52% of the population under 15. Uganda met its Millennium Development Goal (MDG) for under 5 mortality, but there are still 85 000 deaths a year—14% from pneumonia, 8% from diarrhoea, 7% from malaria, 7% from injuries, 6% from HIV/AIDS, and 23% from “other causes,” showing how only so much can be achieved by targeting particular causes. more…

Richard Smith: The deeper causes of the doctors’ strike—a thought experiment

27 Apr, 16 | by BMJ

richard_smith_2014I’m on my way to walk among bluebells, but my mind is on junior doctors engaging in a total strike, not providing even emergency care, for the first time in the 68 year history of the NHS. How did it come to this? I feel that as “a sort of Doctor” for 40 years and somebody who has written probably a million words on healthcare I ought to know, but I don’t. But let me try. This is a thought experiment.

Immediate causes

The immediate cause is the Secretary of State for Health imposing a new contract on junior doctors. He effectively says, “Sod you. I’m fed up with this. We’ve talked for two years and got nowhere. The government has a democratic mandate to introduce a seven day contract, and you, a bunch of overprivileged brats, have no right to deny the will of the people.” I can feel some sympathy for his position, but imposing the contract is an aggressive act. Good people stand up to bullies, and the junior doctors are mostly good people. more…

Richard Smith: The NHS is a fiction, but what’s the story?

26 Apr, 16 | by BMJ

richard_smith_2014Ask somebody “What is the NHS?” and they are likely to answer to “The people who work in it, the buildings they work in, and the tools they use to do their work.” But it clearly isn’t that. The people who work in the NHS come and go, and none were working in the NHS when it began. Buildings too come and go, and the tools are constantly changing. The NHS is not a thing but a fiction, and none the worse for that. Indeed, if we recognise the NHS as a fiction we are more likely to be able to keep it alive. more…

Richard Smith: What are medical journals for and how well do they fulfil those functions?

19 Apr, 16 | by BMJ

richard_smith_2014Last week I gave a talk to the International Society of Medical Publication Professionals entitled “Medical journals: time for something different.” My core argument was that “Medical journals have played an important role in spreading medical knowledge, but they are now beset with problems. Some will transform, most will disappear. New forms of disseminating medical knowledge are appearing and will continue to appear.” As part of the talk I amused myself by reflecting on the functions of medical journals and then scoring them for how well they do with each function. more…

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