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Stuart Buck: Sharing data from past clinical trials

30 Jan, 15 | by BMJ

Stuart_BuckThere was a time when academic and government researchers performed experiments that were clearly unethical—such as letting syphilis go untreated, or asking people to administer severe electric shocks to each other. Ethics review boards sprang up in an important effort to make sure that research on human subjects remained within the bounds of legality and ethics. But for all the good that ethics review boards do, today they often block undeniably valuable research from going forward. The re-analysis of clinical trial data is a recent case where specious ethics objections are used to stymie good research into the effectiveness of drugs given to patients. more…

Desmond O’Neill: Older drivers and medical fitness to drive

19 Jan, 15 | by BMJ

desmond_oneillDoes life really imitate art, or is it the other way round? Listening to an exhilarating live performance by the Philadelphia Orchestra of Till Eulenspiegel’s Merry Pranks, the droll tone poem about a famous trickster by Richard Strauss, I was struck by the notion that this might be the first description of ADHD through music. more…

Saurabh Jha: The overdiagnosed party/ the false positives rave

16 Jan, 15 | by BMJ Group

Saurabh_JhaConsider this equation.

Early Diagnosis = Early Diagnosis + Overdiagnosis (1.1)

This sort of unequal algebra will fail GCSE mathematics. A new NHS initiative is arithmetic defying as well. Patients who think they have symptoms of cancer will be allowed to book medical imaging directly, without seeing their GP. This is to catch cancer early. The logic is impenetrable: early diagnosis of cancer saves lives. more…

Richard Smith: Would you like to die at 75 or 150?

16 Jan, 15 | by BMJ

richard_smith_2014“Sex and death are the only things that can interest a serious mind,” said W B Yeats, so, although more of a flippant than a serious mind, I return to death after my last pondering on the subject that spread literally across the globe. I’m asking whether it would be better to live to 75 or to 150, and if you know me at all you will know my answer.

I’m asking the question because a friend sent from America two interesting articles that address the question. more…

William Cayley: “Enjoy in struggling”

14 Jan, 15 | by BMJ

bill_cayley_2“Struggling is the meaning of life. Victory and defeat are in the hands of God, so one must enjoy in struggling.”

The saying above the doorway caught my attention as I settled in at my friend’s home for a weekend visit. I was a medical student, rotating at a mission hospital in rural Africa, and was visiting a friend in rural Kenya for the weekend. It was my first time away from the hospital for more than a day after arriving a few weeks prior, and it helped me frame my reflections on everything from treating patients with life stories far different from mine, working in far different conditions than my medical school in suburban Milwaukee, and even dealing with the same mundane challenges faced at home of call scheduling, prioritizing theatre time, and figuring out exactly what the supervising physician was expecting. more…

Tracey Koehlmoos: CARE-ing for wounded warriors

30 Dec, 14 | by BMJ

traceykoehlmoosFrom 4-6 December 2014, I had the good fortune to attend the 5th Annual Comprehensive Advanced Restorative Effort (C.A.R.E.) Summit at the Naval Medical Center, San Diego (NMCSD). I travelled to California and attended with representatives from the Medical Officer of the Marine Corps and the Navy Bureau of Medicine, and healthcare representatives of the Marine Corps’ Wounded Warrior Regiment.

The summit was hosted and organized by the CARE Program team, some of whom I had met during their previous visits to Washington, DC, including CARE founder Captain (Dr) Craig Salt, US Navy and program director, and Commander (Dr.) Pete Shumaker, US Navy. more…

William Cayley: Meeting our patients in the midst of their chaos

23 Dec, 14 | by BMJ

bill_cayley_2“Not again . . . ” The mom with the troubled teen is late for their appointment . . .

“Not again . . . ” The elderly widow needs me to explain, one more time, why and how to take her medications . . .

“Not again . . . ” The middle aged diabetes patient has missed yet another routine blood pressure check . . . more…

William Cayley: Thanks for what?

27 Nov, 14 | by BMJ

bill_cayley_2This has been quite a year . . . but then again, what year is not?

Each passing year seems to bring a fresh crop of challenges, crises, obstacles, and frustrations. Being a doctor or, perhaps especially, being a GP is not what it used to be. It’s sometimes hard to tell whether medicine is advancing, or just becoming more convoluted, confused, or even corrupt. Patients seem to want more, when insurers cover less. In the United States, the promise of the Affordable Care Act is running up against the realities of implementation and unexpected hidden incentives—and that’s just in medicine! more…

Ted Alcorn: What we don’t know can kill us—confronting gun violence with data

26 Nov, 14 | by BMJ

ted_alcornIn the United States, the intractable politics of gun violence prevention—and of gun violence itself—rest on a seeming contradiction: we give gun violence far more attention than other causes of preventable death, and yet we have learned far less about it.

A single murder will be recorded by dozens of state and federal agencies, can result in thousands of pages of police reports, and may make headlines and newscasts seen by millions. But hardly any of those data are harnessed or stitched together in a meaningful way to inform policies for preventing future deaths. more…

William C Cayley: Social history on the back roads

31 Oct, 14 | by BMJ

bill_cayley_2Social context and relationships may shape what drives our patients, but sometimes the best way to ponder these is on a drive!

En route to a home visit today, I was met at the edge of town by a road crew doing last-minute sealing work before the onset of winter (despite what you may have heard, Wisconsin only has two seasons—winter and road construction!). As I sat mildly frustrated at the wait until they let us pass, I found myself wondering how many of the road crew, might actually be my patients. (In the end, no faces were familiar, but still it left me thinking).

The home visit was actually relatively straightforward, nothing new going on, no new needs requiring attention. On departing, I decided to both avoid another road construction delay, and take some back roads into town that I seldom explore.

more…

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