I’ve just been listening to a report on the radio about people with learning disorders dying 20 years prematurely because the NHS doesn’t treat them adequately. The Care Quality Commission says that a fifth of hospitals don’t provide dignified care for elderly people. A London professor said at the weekend that 20 000 people may have died prematurely in a group of NHS hospitals. The Global Burden of Disease study reported last week that the UK lags behind other developed countries in indicators of ill health. This all comes soon after the report of Mid Staffordshire NHS Trust describing appalling, abusive care, and 2000 premature deaths. So is it time for radical change? more…

“You’ll do, but you’re not my first choice,” said Frank Dobson then Secretary of State for Health when he appointed Mike Rawlins as the first chairman of the National Institute for Clinical Excellence (NICE) in 1999. Later the blunt speaking Dobson was asked whether NICE would work: “Probably not—but it’s worth a bloody good try.”  Last week, 14 years after those conversations, Dobson was the first speaker at a meeting to say thank you to Rawlins. who is stepping down from the chair of what it’s not hard to argue is one of the world’s most successful health organisations. more…

Nestlé, one of the world’s largest food companies, sells 1.2 billion products a day. This gives it huge potential for good or ill in a world where a billion people are undernourished, more than 2 billion are deficient in micronutrients (iron, iodine, zinc, and vitamin A), and 1.6 billion are overweight. So which is it, good or ill?

Readers of the Lancet and PLoS Medicine have been told that “big food” in general is a bad thing, akin to tobacco companies, and that Nestlé in particular is suspect. Nestlé is strongly associated with breaching the WHO international code on marketing of breast milk substitutes. These alleged breaches occurred in the 70s and 80s and led to a boycott of Nestlé products that still continues (but without much effect, as the company’s sales show). Indeed, the idea that Nestlé regularly breaches the code seems to be widespread, although it hasn’t been true for years and may never have been a major issue. This is a problem for Nestlé: once you are seen as a villain it can be very difficult to promote any other view. more…

We’ve been having this conversation since at least 1945, said a member of the audience at this week’s Cambridge Health Network meeting on partnerships between the NHS and the private sector. The dominant rhetoric now is that partnership between the NHS and the private sector will be essential for improving health and generating wealth for UK Plc, but down in the bowels of the NHS the feeling is often different.

I’ve experienced that feeling directly by joining a private sector company. For many people I became a monster overnight, moving from being the good guy who was editor of the socially conscious BMJ to somebody who had sold his soul to the devil and was out to destroy the NHS. This narrative, which will follow me beyond the grave, amuses me but upsets my wife. Some old friends don’t talk to me. Many others have experienced the same opprobrium on moving to the “dark side.” It’s seen as betrayal. more…

The Arab world, despite its proud intellectual history and some of its countries being among the richest in the world, produces little research. Now the Arab Spring has shaken the whole region, and researchers in the Arab world think that the time has come to relate to the social earthquake and to promote research for health. To that end a collection of Arab researchers, supplemented by a few outsiders like me, met last week at Bellagio, the exquisite villa and estate owned by the Rockefeller Foundation that lies high on a hill at the bifurcation of Lake Como in Italy. more…

When Willie Ramirez was admitted to hospital in Florida his Spanish speaking family said he was intoxicado. There is no exact equivalent of intoxicado in English. It doesn’t mean intoxicated, but that’s how it was translated by the bilingual person who interpreted for the medical staff. Willie was diagnosed as having taken a deliberate overdose. In fact he had had a cerebral haemorrhage. He received the wrong treatment, ended up quadriplegic, and later received a $71m malpractice settlement. more…

Harry Burns, the chief medical officer of Scotland and one of medicine’s philosophers, has spent a lot of time trying to understand why Scotland has such poor health and what might be done. He shared his thinking at a meeting in Edinburgh Royal Infirmary last week.

Scotland has not always had poor health. For most of the past 150 years Scots had a life expectancy around the average for Europe. It’s only in the past 40 years that Scots have fallen behind, and the poor health is concentrated in Glasgow. The rest of Scotland has a life expectancy similar to the rest of Europe. more…

All the political parties and those at the top of the NHS see an important role for entrepreneurs in the latest version of the health service. Those labouring within the service are less convinced, and entrepreneurs have great difficulty finding any customers. The NHS Commissioning Board (or CB, as we are learning to call it) is thus organising a series of meetings for entrepreneurs to help them find their way into the maze of the NHS. I was at the first one this week. more…

There is a sense that if you are not working at something that helps counter climate change (or climate disruption, as it should be called) then you are wasting your time. You are Nero, and Rome is burning. Those of us who work on non communicable disease (NCD) are “lucky” in that most of what needs to be done fits with reducing the harm from climate change. The time has come for the “NCD agenda” to be integrated with the broader “sustainability agenda,” and this was the focus of a joint meeting this week between the London School of Hygiene and Tropical Medicine and the Lancet. more…

Should hubris be a disease, asks my friend Faith. After a second I conclude, “Of course. It’s perhaps the most dangerous disease of all in that it destroys not just individuals, but potentially our whole species.”

I think of hubris simply as men acting as gods (even though I don’t believe in gods). But Wikipedia defines hubris as “extreme pride or arrogance” and then continues: “Hubris often indicates a loss of contact with reality and an overestimation of one’s own competence or capabilities, especially when the person exhibiting it is in a position of power.” more…