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Richard Smith

Richard Smith: The NHS—a terrible thought

25 Nov, 15 | by BMJ

richard_smith_2014There is great reluctance in Britain to consider any other kind of funding for the NHS apart from taxation, but we are surely close to a time when we will have to consider it. This morning I awoke with the thought, which felt terrible, that funding through taxation is a straitjacket that is causing increasing pain. more…

Richard Smith: What causes cholera? A Victorian debate

18 Nov, 15 | by BMJ

richard_smith_2014Yesterday I was in The Cholera Hospital in Dhaka, Bangladesh; today I’m reading about a highly emotional debate about the causes and treatment of cholera that took place in India in the 1857, during the Indian Mutiny. Both experiences have taught me something, and you might learn something as well.

Cholera today

Cholera is endemic in Bangladesh, as it is in some 50 countries, with two peaks during the year, one just before the rainy season begins in April and one after it ends in October. During the peaks The Cholera Hospital may have a thousand admissions a day, most of the patients have cholera. The hospital is part of icddr,b [formerly the International Centre for Diarrhoeal Disease Research, Bangladesh], and it leads the world in the treatment of cholera. If patients arrive alive they leave alive. Nobody has to pay for treatment, and the hospital is well known to the poor of Dhaka, a city of 17 million people where a third live in slums. more…

Richard Smith: The Closer We Get

9 Nov, 15 | by BMJ

richard_smith_2014The Closer We Get shows the last months of a woman’s life after she has had a stroke and tells the complex story of a family as they gather around the mother. It’s an intense film that held my attention for every one of its 87 minutes, much more so than The Lobster and Suffragette, both of which I’ve seen in the past week. There’s much to be learnt in the film by health workers and, indeed, by everybody. more…

Richard Smith: The Catch 22 of health strikes

29 Oct, 15 | by BMJ

richard_smith_2014Junior doctors are clearly extremely angry. Some 15 000 junior doctors recently protested against changes in their contract. As there are about 55 000 junior doctors in England, that’s the equivalent of about 16m of the general population protesting a change. That would be a revolution. But why are junior doctors so angry and what should they do about their anger?

The standard line is that doctors are protecting “patient safety, the wellbeing of doctors, and the future of the NHS.” That seems to me spin. more…

Richard Smith: Health research when carbon matters more than money

27 Oct, 15 | by BMJ

richard_smith_2014As I write this, the strongest hurricane ever detected in the Western Hemisphere is approaching the coast of Mexico, where my son lives. It may have nothing to do with climate change (or disruption, as I prefer to call it), but it probably does. Recently we heard that the permafrost is thawing faster than ever and may soon release huge amounts of methane, accelerating climate disruption. Yet most of us, including health researchers, carry on as if nothing is happening. How might health research contribute to averting disaster? I’m part of a group discussing this, and I’m taken by the attractiveness of a simple idea that could have important results. more…

Richard Smith: A better way to publish science

22 Oct, 15 | by BMJ

richard_smith_2014Journals have been the main way to publish scientific research for 400 years, and remarkably they still are despite 20 years of the World Wide Web. But it’s becoming increasingly clear both that the journal model is beginning to creak and that better models are appearing. I’m working with F1000, and we propose moving from a world where publishers and editors are involved in making judgments on science to one where publishers simply provide a service to scientists and the funders of science to help them rapidly disseminate their findings. This move should address at least some of the many problems of research and journals. more…

Richard Smith: How public health moralists are promoting harm from tobacco and helping the tobacco industry

15 Oct, 15 | by BMJ

richard_smith_2014David Sweanor, a Canadian lawyer who has many times successfully sued the tobacco industry, believes that those who instinctively react against e-cigarettes on moral grounds are making a bad mistake. We all, he says, have the fast form of thinking that is often morally driven, but when it comes to ways of reducing harm from tobacco we need the slow thinking that is logical, scientific, and harder work. He made his case convincingly at a C3 Breakfast Seminar this week. more…

Richard Smith: How global health can help the NHS

13 Oct, 15 | by BMJ

richard_smith_2014Africa has 25% of the global health burden and 2% of the health workforce. In contrast, North America has 2% of the health burden but 25% of the health workforce. This is the inverse care law (those who need healthcare the most get the least) on a gargantuan scale. And now the US is trying to recruit 500 000 more nurses to implement Obamacare. It may not feel like it to those in the NHS, but it too has both more staff than it “deserves” and a shortage of health workers. The Global Health Exchange, which was launched earlier this week in Manchester, is one response to this paradox.  more…

Richard Smith: Memory—the view from the humanities

5 Oct, 15 | by BMJ

richard_smith_2014To a neuroscientist, said Hugo Spiers, a psychologist from UCL chairing a meeting at LSE last week, memory is just a physical and chemical arrangement of synapses. That’s a supremely reductionist view, the view of a NeuroNazi, said Sebastian Groes, a professor of literature from Roehampton University. Although chaired by the neuroscientist, it was the views of the literature professor, a futurologist, a science fiction writer, and a philosopher that dominated the meeting, but they couldn’t even agree on what memory is. more…

Richard Smith: If Volkswagen staff can be criminally charged so should fraudulent scientists

28 Sep, 15 | by BMJ

richard_smith_2014A man who steals a milk bottle may face a criminal charge. In contrast, a scientist who invents data, defrauds funders, and publishes fabricated data that may lead to patient harm is highly unlikely to face criminal charges. The news that Volkswagen staff may be criminally prosecuted for manipulating emission tests raises again the question of whether scientific fraud should be a criminal offence.

I’ve blogged on this before, arguing that there are three main arguments for making scientific misconduct a criminal offence. Firstly, it’s no different from financial fraud, which is a criminal offence, in that resources (often public funds) are misused. Secondly, universities are poor at conducting investigations and gathering evidence, whereas it’s an everyday job for the police. Thirdly, universities and other employers of researchers face a painful conflict of interest in exposing one of their researchers as fraudulent and have often failed to properly investigate, punish, and put the record straight. more…

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