“No single law—no set of laws can eliminate evil from the world, or prevent every senseless act of violence in our society. But that can’t be an excuse for inaction. Surely, we can do better than this.”

These were President Obama’s words to the people of Newtown, Connecticut, where last week 20 children and six adults were slaughtered in one of the worst mass shootings in U.S. history. more…

The characteristics of health systems are complexity, uncertainty, opacity, poor measurement, variability in decision making, asymmetry of information, conflict of interest, and corruption. They are thus largely a black box and uncontrollable, said Gianfranco Domenighetti of the Università della Svizzera Italiana at a meeting in Bologna on La Sanità tra Ragione e passione (Health through reason and passion). The meeting was held to celebrate the life and work of Alessandro Liberati, the founder of the Italian Cochrane Centre, who died last year. more…

A few days ago a disturbed young man in Newtown, Connecticut, shot his mother before going to the primary school where she worked to murder 20 children, aged between six and seven years old, and six staff. The immediate response was disbelief and shock at yet another mass shooting in America. But this was followed, almost at once, by the question of why the shooting happened and how it is that the United States seems incapable of preventing such events from happening with depressing regularity. more…

About 15 years ago I sat in on the superb Doctoring programme at UCLA that taught medical students the art of medicine through role play with actors.

One scenario featured a teenage boy whose behaviour was causing concern at home and school. I don’t remember all the details of the case, but the gist was that the boy was truanting and was increasingly withdrawn. He replied to his student interviewer in monosyllables. He seemed angry. Was he depressed too? more…

Any day now the Obama administration is expected to release the long delayed Sunshine rule which will determine how drug and device makers are to gather and publish data containing their financial relationships with physicians. At least that is what many companies and consumer advocates are hoping, but a strain of anxiety is noticeable among insiders over the prospect of yet another holdup.

The rule, which became law as part of the sweeping healthcare legislation known as the Affordable Care Act, has been a regular source of intrigue and controversy since it was proposed a few years ago. The agency charged with developing the rule—the Centers for Medicare & Medicaid Services (CMS)—delivered a final version in late November, but the contents have remained undisclosed. more…

You might not know this, but I am over 40 and I am a woman.

In the US having breasts and being over 40 means something to doctors and patients. It is a healthcare trigger to start having annual mammograms. If you are reading this in the UK, Canada, or Europe, you might be surprised because your own guidelines are so different—starting at 50 and with greater spacing (2-3 years), which is where the evidence show us we get the most benefit from routine screening. more…

Having decided to write a blog during this academic year living in the US, I hadn’t anticipated my tardiness would be because moving the family overseas was vastly more effort than I anticipated. A stroke in a family member at home came suddenly and unexpectedly, and a hurricane hit the city I’m currently calling home. The after effect of Sandy still continues to disrupt normal life for many. These events, combined with an unpredictable, and at times ugly, presidential election has made the start of the Harkness fellowship rather fascinating, if at times nerve wracking.

My interest in the Harkness fellowship in healthcare policy and practice originated some years ago whilst I was working at the Department of Health, and taking part in discussions comparing UK and US healthcare. I’ve now found, though, that actually being here, immersed in the system, has given me a fresh understanding of just how complex healthcare is across the Atlantic, something that was harder to appreciate from within the Ivory Towers. For all the learning to be had from best practice, like integrated care arrangements, there are many other warnings of paths better not trod. more…

As an NHS GP I learned that healthcare is fundamentally locally provided and delivered through fostering long term relationships. However, the convergence of mobile technology and big data have the potential to profoundly change the way care is delivered. Should existing power brokers see this as an opportunity or a threat and what does this mean for the NHS?

This week, we were privileged to receive a delegation of UK health leaders at MIT’s shining temple of innovation, The Media Lab. In a brilliant white conference room, myself and four other MIT affiliated engineers and physicians discussed technology and health. We discussed a question that stuck in my mind and has inspired this post, “is it best to leave the Americans to do the trial and error and then take what works back to the UK?” more…

You would sometimes be forgiven for thinking that we are now living in the last days of the traditional medical journal. Everything from payment models, to access, and even peer review is up for grabs.

Editors are a needless middleman, messing with the researchers’ genius and peer reviewers merely inflict their own bias on the reader, multiplying the no doubt manifold pre-existing faults of the research.

Well here at the American Heart Association in Los Angeles I am having my faith restored.  Journals, good ones at least, do an incredibly important job. more…

Back in my early days as a radical medical student (a small, select group in the Belfast of the early 1970s) one of the international figures I admired greatly was Angela Davis. I was amazed and delighted to find her billed as the main speaker at the closing session of the American Public Health Association’s annual meeting in San Francisco.

She still sports an afro hairstyle (admittedly of more modest dimension than in the 1970s) and her politics have lost none of their razor sharp radicalism. In her opening remarks she commiserated with all those affected by Hurricane Sandy while castigating the prominent politicians who in their statements ignored this latest screaming reminder that the world’s climate is changing and that human activity is to blame.
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