The adrenaline rush was unbearable. I could feel my palms sweating. When I tried to clip the microphone on to my coat, my hands were trembling. Eager looking eyes of the audience were pinned on me. I took a deep breath and with my heart still pounding, I said, “Hello everyone!”
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WHO is currently setting priorities for research in chronic or non-communicable disease, and generally the first research question is “Will what has worked in rich countries work in low and middle income countries?” We know, for example, what to do to reduce deaths from heart disease and how to reduce tobacco consumption. But interestingly when it comes to nutrition we don’t know what to recommend. The advice for rich countries may be wholly inappropriate for poor countries. more…

BMJ bloggers are in the habit of going to exotic places to listen to exciting lectures. In my time I’ve done my share of all that but a few weeks ago my medical education leapt ahead in an unlikely place – the Malvern Giant Flea Market.  In a subsidiary role as my antique dealer wife’s second opinion and general purposes porter, I rarely get to buy anything but, on this occasion, my eye was caught by a pair of medals on which serpents and staffs figured. A closer look disclosed one to be a medal commemorating the 1961 Hunterian Professor of the Royal College of Surgeons of England, Frank Groves Ellis (1925-2003). The other was awarded to Ellis when he was Lettsomian lecturer of the Medical Society of London in 1975. more…

If I asked a physiologist to show me where her conscience is, I’m fairly sure she’d not be able to.  Yet, it seems, a great many doctors appeal directly to their consciences, or at least wish to be free to do so.  This is a little strange.  If a patient says “God makes me do it” suspicions arise.  So why should a doctor be at liberty to appeal to something beyond the empirically demonstrable?  I work in “health law and ethics”, and see lauded the great march away from a “Bolamised” system, wherein clinical judgement counted (officially) for pretty much everything, and values that worked against such professional opinion could be subjugated in accordance with the maxim “Doctor knows best”. more…

Reader I am sick, sick if not quite unto death then very nearly unto despair. There is a gnawing within that will not let me rest. I have searched in vain for what to call my malediction. I have been sacking my shelves, rifling my dictionaries and encyclopedias, consulting with the most eminent physicians, but it hovers elusive just beyond the reach of diagnosis. The symptoms are daily growing stronger: an indignant tightening in the chest; bouts of impotent rage; a hopeless bewildered clamouring after social justice. Finally, reluctantly, after months of fruitless searching I have decided to take the matter into my own hands, to become my own diagnostician. All good maladies require a name and to mine I have given the moniker Mandelson’s Distemper, in honour of the most vexatious of its symptoms. For reader I am not relaxed, not at all relaxed - and so very much not “intensely” relaxed - about people getting filthy rich. more…

That articulated lorry hurtling towards you may be driven by one of your fat beer drinking patients- who just has fallen asleep at the wheel. Sleep apnoea used to be a rather esoteric research field in the backroads of respiratory medicine but is now mainstream or, more alarmingly, main road.  Respiratory physicians may joke that if you make your patients wait 45 mins for their appointment, you need only investigate those who doze off in the waiting area. But, if the prevalence is 4% and rising in our increasingly obese population, with links to hypertension and diabetes, perhaps we should take a more active approach. Should we be doing routine pulse oximetry in all our obese patients? more…

Frank Wells, who is probably the UK’s first professional fraud buster, says he has “yet to meet a female research fraudster.” All the 26 cases of proven villainy he has dealt with have been men. That’s interesting, but not quite enough to fill a blog and perhaps says more about the sex ratio of senior UK researchers, at least in the past, than anything really interesting about research fraud. But, still, 0 out of 26 is pretty impressive (well done, girls!). more…

The swine flu vaccine is officially here. The UK government announced on Friday that over 400,000 doses of the swine flu vaccine will be delivered to hospitals this week. The first to get the jab (from Wednesday) will be hospital inpatients belonging to at-risk groups and hospital staff. Next week GPs are due to start vaccinating patients according to their priority status, which are as follows (top priority first): people aged six months to 65 years with underlying health problems and the immuno-suppressed; pregnant women; household contacts of people with compromised immune systems; people aged over 65 with health problems. The Daily Mail are characteristically concerned about the vaccine, in particular its use in children. more…

Last week I fell onto an outstretched hand and clinically had an obvious fracture on the ulnar side of my left wrist.  Interestingly, the very diligent nurse practitioner who examined me became fixated on my scaphoid - having pushed extraordinarily hard in the anatomical snuffbox and eliciting pain.  Scaphoid views were requested and no fracture seen.  I expressed concern that perhaps the fracture was elsewhere, but was promptly told: ‘chances can’t be taken with the scaphoid’.  I was bundled into a futura splint, given a photocopy of my notes, instructions to return ten days later and shown the door.  I couldn’t help but read the notes the minute I walked out of A+E.  F.R.O.M. (full range of movement) dutifully scribed (almost everywhere); surprised me as I couldn’t move it even slightly. more…

Medicine has always been a pretty one-way business. We know, they don’t. It is us that ask the questions, their bodies that slip under our knives. Patients of course have always had their own opinions, told their side of the story to families and friends in the pub, kept their own counsel around the factory gates and the water cooler. But mostly we have been ignorant whether they loved us or loathed us. more…