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The BMJ Today: Profanities and protests in public health

17 Sep, 14 | by BMJ

tom_m_sepPublic health has become heated, with the fiery debate over e-cigarettes pushing one public health director over boiling point, and public health leaders across Europe becoming incensed by changes at the European Commission.

As Gareth Iacobucci reports, John Ashton, the president of the UK Faculty of Public Health, described a supporter of e-cigarettes on Twitter as “an obsessive, compulsive, abusive onanist.” He followed this with a question: “Have you always been an anonymous c..t?”

The BMJ wasn’t being prudish in its presentation of Ashton’s comments. (In fact, for those interested in such matters, The BMJ’s house style is not to censor any language.) But Ashton himself chose not to spell out his message in full, which may speak volumes for the continued power of some phrases in the English language. more…

The BMJ Today: Medicines have a new competitor—gamification

16 Sep, 14 | by BMJ

Gamification is a theory, not just a trend. It is the use of game mechanics to solve real world problems, and that includes those that originate in the body. If the word instils in you a sense of fear and dread—as it did in me—look no further than this Feature by Stephen Armstrong to feel confident about talking gamification with your colleagues.

Anxiety in children, adherence to cancer medication, physiotherapy exercises, Alzheimer’s disease, schizophrenia, and obesity have all been targeted with specially designed games. Gamification’s efficacy in medicine is largely unknown. But investment in research is growing. more…

The BMJ Today: You don’t always get what you pay for

15 Sep, 14 | by BMJ

On today, researchers have found that a much cheaper treatment for wet age related macular degeneration causes no more side effects than the far more expensive licensed treatment.

Zosia Kmietowicz reports that the authors of the Cochrane review have found that ranibizumab (Lucentis), which is most commonly used in the UK and costs about £700 an injection, is no more effective than bevacizumab (marketed as Avastin), which costs about £60 an injection. Researchers have previously estimated that using bevacizumab, rather than ranibizumab, could save the NHS £84m a year. more…

The BMJ Today: Watch out for the quiet ones

12 Sep, 14 | by BMJ

sally_carterI’m always pleased to see that people keep an eye on changes that are announced quietly by big organisations. Jim Murray alerts us to a discreet switch made by the European Commission. He explains in his blog: “In the UK, the Department of Health is the ‘parent,’ or sponsoring department, for the Medicines and Healthcare Products Regulatory Agency (MHRA). That seems reasonable. It would be surprising if the Department for Business, Innovation and Skills (BIS) were given the job, yet something like this has just happened in the new European Commission announced today.” more…

The BMJ Today: The perils of not keeping your mouth shut

11 Sep, 14 | by BMJ

tiago_villanueva A few weeks ago, I had to take parenteral antibiotics for a condition that was not improving with oral antibiotics. Moreover, in my native Portugal it is still common, for example, to prescribe parenteral penicillin for bacterial tonsillitis since for some reason oral penicillin is not available there. more…

The BMJ Today: Medical device regulation – still out of joint

10 Sep, 14 | by BMJ

The introduction of new orthopaedic implants has for some time been a major focus of attention within scientific and policy circles since concerns about certain devices used in total hip replacements were brought into the spotlight. One of the conclusions of a BMJ feature by Deb Cohen in 2012 was that “After a series of failures, device regulation is in need of radical change.” more…

The BMJ Today: Read this, but no emailing please

9 Sep, 14 | by BMJ

Arterial and venous thromboses are common serious postoperative complications (about 8% of surgical procedures are followed by a thrombosis). The fact that they are still so common despite years of research suggests we haven’t yet cracked what causes them and how to prevent them. Although some risk factors like malignancy and previous thromboembolism are well established, others are less clear. more…

The BMJ Today: Communication of risk – a week of reflection

8 Sep, 14 | by BMJ

Emma-ParishThis week has highlighted for those in healthcare the intricacy of communicating risk to patients and their families. In an emotive blog relating to the case of Ashya King, Tessa Richards highlights her concerns regarding communication with families around complex treatment decisions, and has implored the medical professions to reflect on their ability to do this effectively. The author suggests doctors “struggle to find the time—or lack the skill or motivation—to listen to patients”. If you have an opinion or experience to share, we would welcome your rapid responses.


The BMJ Today: A story in need of an end

5 Sep, 14 | by BMJ

helen_macA good story has a beginning, a middle, and an end. A few days ago, we published a sad story in The BMJ Analysis section about the use of beta-blockers in patients undergoing major surgery at high risk of cardiovascular disease.

The story had a hopeful beginning, in the 1990s, as the medical community was striving to reduce perioperative morbidity and mortality. Researchers investigated whether beta-blockers could reduce perioperative myocardial infarction in patients at high risk of cardiovascular disease. Some of the family of DECREASE trials were key in demonstrating they did, and the European Society of Cardiology Guidelines 2009 gave a strong steer to doctors to prescribe the drug. more…

The BMJ Today: Bladder cancer—things can only get better

4 Sep, 14 | by BMJ

sarah_paytonAs diseases go, bladder cancer has a pretty raw deal. It lacks the attention and research funding given to other urological cancers (I’m looking at you prostate cancer), and—perhaps most worryingly—it is the only one of the top 10 cancers in the UK for which survival is getting worse.

One particular problem is delayed diagnosis, which disproportionately affects women. Gross haematuria is the most common presenting symptom, and evidence indicates that women experience not only more, but also longer, delays in diagnosis owing to repeated misdiagnoses of urinary tract infection.

In terms of expediting diagnosis, new research reported in The BMJ this week highlights the importance of recognising that non-visible (or microscopic) haematuria can also be an early symptom of bladder cancer. more…

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