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US healthcare

Diana Zuckerman: “What does it mean to march for women in 2017?”

23 Jan, 17 | by BMJ

Did the Women’s March on Washington, across the US, and in major cities around the world have anything to do with medical care? Yes and no.

I’ve lived and worked in Washington, DC for more than 30 years, and I’ve seen a lot of demonstrations, and participated in a fair number as well. But I’ve never seen a demonstration quite like the Women’s March that was held the day after the inauguration of Donald Trump.

Much of the media attention before the march was on the celebrities that were planning to attend. And they were there—bold faced names like Scarlett Johansen and Katy Perry, Senators and Congresswomen, and numerous celebrities whose names I am too old to recognise. But because the permit was for an area that was much too small for the crowd that showed up, the vast majority of the approximately half million women, men, and children never saw or heard most—perhaps any—of the 4-hour program.  more…

Neel Sharma: Fired up, ready to go!

20 Jan, 17 | by BMJ

neel_sharmaAlthough I’m not usually political by a long shot, the presidential transition in the US today has made me reflect on Barack Obama’s legacy and his mantra of: “Fired up, ready to go!”

I transplanted these words temporarily and thought back to where I currently stand as a junior doctor. When I left medical school I was naïve. I assume most of us were. We eventually realise when we begin to practice medicine, that the system that we work in is not always so conducive to effective working practice. I’m sure readers are avidly digesting the state of the NHS this winter. I also realised that as juniors we focus on safe and effective patient care, but our focus can be distracted by our worries of what those above us think. more…

David Kerr: Big pharma in Trumpland

19 Jan, 17 | by BMJ

david_kerr_2015picDonald Trump has big pharma in the crosshairs. Using classic #TrumpSpeak, the soon to be 45th President of the United States hinted recently that Medicare, the biggest buyer of drugs in the US, could soon be able to negotiate drug prices directly with the pharmaceutical industry.

This is something big pharma has spent years and millions of dollars in trying to prevent. According to Trump, the pharma industry “has been getting away with murder . . . we’re the largest buyer of drugs in the world and yet we don’t bid properly and we’re going to start bidding and we’re going to save billions of dollars.” Unusually, given the current combative nature of domestic politics here in the US, his idea has also been espoused by political opponents including Bernie Sanders and Hillary Clinton. Although short on detail, Trump’s comments caused big pharma to lose almost $25 billion in market value the same day. more…

William Cayley: Measurement or action?

29 Dec, 16 | by BMJ

bill_cayley_2As our measurements and metrics in medicine proliferate and multiply, it is exceedingly tempting to think that our increased ability to measure correlates directly with an increased ability to care or cure . . . but is this really the case?

It’s been reasonably well established that just doing a test to “rule out” a condition does not actually provide much assurance to patients. Testing to reassure offers little reassurance. 

However, on the other side of that supposition lies the even more important question of whether testing to diagnose actually provides assurance or motivation. more…

Jarron Saint Onge: US ban on smoking in public housing—policymakers must take into account the potential to harm

16 Dec, 16 | by BMJ

jarron-saint-ongeWhen the US Housing and Urban Development Department (HUD) recently announced it will require all public housing developments in the US to go smoke free, federal officials were correct to attack a significant and pervasive problem—smoking exposure among low income Americans.

However, it’s less clear if their attempted solution is the best and most effective way to solve this problem.

The goals are to reduce secondhand smoke exposure, aid smokers to quit, as well as to more…

Katherine McKenzie: Supporting human rights, one patient at a time

13 Dec, 16 | by BMJ


I saw the first asylum seeker around ten years ago in my clinic. He came from a country with an autocratic president against whom he had peacefully protested. The government would not accept dissent from its citizens and they arrested, detained, and tortured him. He was released, but he was told that he would be killed for any future real or perceived opposition. He fled to the United States for safety, and eventually presented to my office for a medical forensic exam to document the scars of his torture. more…

William Cayley: Comprehensiveness, diversity, and primary care

6 Dec, 16 | by BMJ

bill_cayley_2As medicine continues to grow in complexity and diversity, it is fair to ponder what roles may be best suited for the medical workforce of the future. A recent opinion piece argued that since we have no models permitting “any single physician to simultaneously and effectively serve the many patient subpopulations that exist,” we need to recruit, educate, and sustain a “diverse” health and healthcare workforce.

While I agree wholeheartedly that our workforce of the future needs caregivers who are technically skilled and adept at interdisciplinary collaboration, we also need to balance the increasing degree of specialization and compartmentalization in healthcare with a genuine appreciation for the breadth and generalism of primary care and family medicine. more…

Vineet Chopra et al: Motivational interviewing for healthcare providers

30 Nov, 16 | by BMJ

Improving patient safety through behavioral change is something that all healthcare providers strive to achieve. Supported by a three year grant, we are involved in a new way of doing this by using motivational interviewing (MI) among staff to improve patient outcomes.

A technique typically used by clinicians for patients, MI aims to empower and guide individuals towards health behavior change. Research studies have shown that MI achieves superior results compared to traditional patient education interventions for health behaviors including tobacco use, physical inactivity, and weight gain/obesity. more…

John J Park and Rifat Atun: Will global health be Trumped?

30 Nov, 16 | by BMJ

Donald Trump’s election as the 45th President of the United States (US) has left many in the global health community startled. What lies ahead for the future of global health and sustainable development, especially for millions of vulnerable people largely dependent on US assistance for health?

When Donald Trump famously announced: “I am not running to be President of the World. I’m running to be President of the United States,” he was probably not considering the fact that as the new US President, he would have tremendous influence on global health. [1] His responsibilities as President will include, among others, appointing the heads of the US Agency for International Development (USAID), Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), and National Institutes of Health (NIH). Collectively, these organizations account for a large proportion the US Government’s $10 billion overseas assistance for health each year. [2] more…

The consequences of repealing and replacing Obamacare: A troublesome paradox

22 Nov, 16 | by BMJ

evan_goldsteinTo the approval of millions of Americans, President-elect Donald J Trump campaigned on directing the US Congress to repeal the Affordable Care Act (ACA or Obamacare). As the dust settles from Mr Trump’s surprising victory on 8 November, the Republican Party finds itself with looming control of all three branches of the US federal government.

Paul Ryan, the US speaker of the House of Representatives, is ready to oblige Mr Trump’s promise to repeal the ACA, having made a similar promise in his A Better Way plan, the presumptive blueprint for the Republican Party—and soon Americanpolitical agenda. more…

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