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US healthcare

Jim Murray: Abbvie withdraw case against European Medicines Agency

16 Apr, 14 | by BMJ

jim_murrayAbbVie have withdrawn their legal challenge against the release of certain company documents on Humira (adalimunab) by the EMA. This followed an offer by the agency to redact parts of the document originally intended for release.

Is this good news? There are those who think it is, but we cannot be entirely sure at this stage, and may never know for certain unless someone manages to see the parts that were redacted. more…

Jen Gunter: The Tamiflu talisman

14 Apr, 14 | by BMJ

jengunterOseltamivir (Tamiflu) has been prescribed for my son, Oliver, multiple times. It’s possible he has taken this drug more than anyone.

Oliver was born at 26 weeks gestation and was left with significant bronchopulmonary dysplasia. He also has a complex congenital heart disease, now partially repaired, but he is left with moderate pulmonary valve regurgitation and right ventricular hypertrophy. This one-two pulmonary-cardiac punch has left him medically fragile. more…

The BMJ Today: The glass ceiling, upcoming elections, and big tobacco

9 Apr, 14 | by BMJ

As I look around our open plan office, towards where our editor, Fiona Godlee, sits, it would seem that the glass ceiling has been shattered at The BMJ. But, in her personal view, Medicine still needs feminism, Helena Watson argues that there are “legions of feminist issues still left to fight.” more…

The BMJ Today: If you hear hoof beats in Texas think of horses, not zebras

8 Apr, 14 | by BMJ

As Saurabh Jha writes, “The likelihood that someone with cerebral aneurysm hit by a bat develops subarachnoid hemorrhage (near certainty) is not the same as the likelihood that someone who develops subarachnoid hemorrhage after high impact trauma has an aneurysm, hitherto undisclosed (very low).” But would you order tests so you could absolutely rule it out? Would you perhaps order further tests to rule out bleeding brain metastases from lung cancer? Jha asks us to stop “hunting for zebras in Texas” and put an end the “rule-out” culture that pervades medicine. more…

Hemal Kanzaria et al: How can we reduce medical waste in US hospitals?

4 Apr, 14 | by BMJ

hemal_kanzariaUS hospitals annually discard millions of dollars of clean, unused medical equipment due to procedural excess or federal regulations. [1,2] Many health professional students do not recognise the magnitude of this waste or the extent of worldwide inequities in access to such supplies. In an era of value driven care, it is critical to engage students in cost conscious care and waste reduction efforts.

Remedy at University of California San Francisco (R@UCSF) is a student implemented, service learning initiative for the responsible redistribution of medical supplies to underserved communities. [3] Through an experiential curriculum, the program objectives are a) to reduce disparities in access to healthcare supplies by providing clean and needed equipment to under resourced communities and b) to expose students to the magnitude of medical waste in US hospitals. more…

The BMJ Today: Is medicine marching towards an era of greater openness?

4 Apr, 14 | by BMJ

Tiago_VillanuevaIn the latest Endgames picture quiz, a 41 year old man presents to the emergency department with a two week history of worsening shortness of breath, productive cough, intermittent fever, night sweats, and non-pleuritic pain in the right side of the chest wall. He was diagnosed with a pulmonary abcess secondary to community acquired pneumonia. There are no published guidelines regarding the management of pulmonary abscess, which includes antibiotics that are in part chosen according to clinical judgment rather than a sound evidence base. more…

The BMJ Today: Paying people to live healthier lives and tackling climate change

3 Apr, 14 | by BMJ

This week, the Intergovernmental Panel on Climate Change (IPCC) released its Fifth Assessment Report. The scientists who wrote it warn of the serious impact that climate change—unequivocally influenced by human activity—will have on humans and other species in the planet. The IPCC calls for world leaders and policy makers to promote adaptation strategies to mitigate the implications of climate change for future generations. Climate change may be the greatest challenge we face as a species yet many people have difficulty grasping its implications. The changes are abstract, will occur in the future, and mitigation strategies have economic costs and limited short term benefits. In addition, several institutions, corporations, and individuals with vested interests refute the claims of mainstream scientists and promote the fallacious view that there is great uncertainty around the predictions of the IPCC and that many in the scientific community are skeptical about the impact of human activity on climate change. more…

The BMJ Today: Vitamin D, probiotics, and polio

2 Apr, 14 | by BMJ

We have been longing for a final word on whether vitamin D supplements improve health. An umbrella review published today included 107 systematic literature reviews and 74 meta-analyses of observational studies looking at serum levels of vitamin D, as well as 87 meta-analyses of randomised trials testing vitamin D supplements. A total of 137 outcomes were included, spanning a wide array of diseases.

We’ve also published a systematic review and meta-analysis of 73 cohort studies with over 800 000 participants and 22 randomised trials with 30 000 participants that examined the link between vitamin D and deaths due to cardiovascular disease, cancer, and other causes. more…

Gavin Yamey: Soldiers, academics, and an unusual health initiative

1 Apr, 14 | by BMJ

gavin_yameyIt’s not every day that you find yourself at a work meeting chatting to a soldier who led the Counterinsurgency Advisory and Assistance Team in Afghanistan and the doctor who directed the largest global health initiative in human history.

Retired US Army Colonel Joseph Felter is now a Stanford University academic with expertise in studying the root causes of political violence. Eric Goosby, an HIV physician at the University of California, San Francisco (UCSF), who was among the first clinicians in San Francisco to treat the disease at the start of the pandemic, led the $US45 billion global AIDS initiative PEPFAR—the US President’s Emergency Plan for AIDS Relief. more…

The BMJ Today: Selective decontamination revisited and healthcare reform in Massachusetts

1 Apr, 14 | by BMJ

georg_rogglaRichard Price and co-workers published a network meta analysis evaluating the effect on mortality of selective digestive decontamination (SDD), selective oropharyngeal decontamination (SOD), and topical oropharyngeal chlorhexidine in patients in general intensive care units. They found that both SDD and SOD confer a mortality benefit when compared with chlorhexidine. more…

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