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The BMJ Today: Profanities and protests in public health

17 Sep, 14 | by BMJ

tom_m_sepPublic health has become heated, with the fiery debate over e-cigarettes pushing one public health director over boiling point, and public health leaders across Europe becoming incensed by changes at the European Commission.

As Gareth Iacobucci reports, John Ashton, the president of the UK Faculty of Public Health, described a supporter of e-cigarettes on Twitter as “an obsessive, compulsive, abusive onanist.” He followed this with a question: “Have you always been an anonymous c..t?”

The BMJ wasn’t being prudish in its presentation of Ashton’s comments. (In fact, for those interested in such matters, The BMJ’s house style is not to censor any language.) But Ashton himself chose not to spell out his message in full, which may speak volumes for the continued power of some phrases in the English language. more…

Duncan Jarvies: Preventing Overdiagnosis 2014—I am not legion

16 Sep, 14 | by BMJ

I’m against overdiagnosis, overcooked food, and over long films, said David Haslam, chair of the National Institute for Health and Care Excellence.

All of us probably agree—especially when it comes to overcooked food—which is part of the problem.

At the Preventing Overdiagnosis conference in Oxford, the big topics are diabetes, hypertension, and statins. Lifestyle diseases that we are regularly treating, with the aim of reducing incidence, even where treatment will make very little difference to individual patients. more…

Ahmed Rashid: “Physics envy” in evidence based medicine

16 Sep, 14 | by BMJ

ahmed_rashidResearchers have long debated the relative complexity and importance of different scientific disciplines.

Traditionally, sciences that used the most mathematical equations—such as physics—were deemed the most intellectual and placed at the top of an academic hierarchy, while social sciences were consigned to the lowest point.

Willard Van Orman Quine, who held the Edgar Pierce chair of philosophy at Harvard University for over two decades, famously exemplified this belief in 1981: “Physics investigates the essential nature of the world, and biology describes a local bump. Psychology, human psychology, describes a bump on the bump.” more…

Richard Smith: Is global health too medicalised?

16 Sep, 14 | by BMJ

richard_smith_2014When I teach young doctors in Amsterdam about responding to NCD (non-communicable disease) in low and middle income countries, I ask them how they would allocate 100 units of resource. I give them four buckets.

One bucket is for treating people with established disease: patients with heart attacks, strokes, cancer, and chronic obstructive pulmonary disease. The second bucket is for treating metabolic risk factors, such as hypertension, hyperlipidemia, and raised blood glucose. The third bucket is for acting on the four risk factors—tobacco use, poor diet, physical inactivity, and the harmful use of alcohol—recognising that many of the interventions will be political, actions like raising the price of tobacco. The fourth bucket is for working on social determinants, such as poverty, housing, globalisation, and urbanisation. I ask the doctors not only how they will distribute their resources, but what they will do with the resources. more…

The BMJ Today: Medicines have a new competitor—gamification

16 Sep, 14 | by BMJ

Gamification is a theory, not just a trend. It is the use of game mechanics to solve real world problems, and that includes those that originate in the body. If the word instils in you a sense of fear and dread—as it did in me—look no further than this Feature by Stephen Armstrong to feel confident about talking gamification with your colleagues.

Anxiety in children, adherence to cancer medication, physiotherapy exercises, Alzheimer’s disease, schizophrenia, and obesity have all been targeted with specially designed games. Gamification’s efficacy in medicine is largely unknown. But investment in research is growing. more…

Daniel Maughan: What has climate change got to do with mental health?

15 Sep, 14 | by BMJ

This blog is part of a series on sustainable healthcare, which looks at health, sustainability, and the interplay between the two. The blog is coordinated by the Centre for Sustainable Healthcare and shares ideas from experts across the healthcare field.

The World Health Organization and the Lancet Commission have both stated that climate change is the largest threat to human health in the 21st Century. Does this threat extend to mental health? Weather systems are likely to become more unstable as global temperatures rise, but could unstable weather have an effect on the development of mental disorders? more…

Richard Lehman’s journal review—15 September 2014

15 Sep, 14 | by BMJ

richard_lehmanNEJM 11 September 2014 Vol 371
1016  Ticagrelor has had mixed fortunes since it was introduced as a new thienopyridine platelet aggregation inhibitor a few years ago. The PLATO trial left lingering doubts whether it is better than the much cheaper clopidogrel when used in acute coronary syndromes. Rather than attempting to resolve these, the latest trial (ATLANTIC) compares prehospital administration of ticagrelor with in-hospital administration in patients undergoing immediate percutaneous coronary intervention for ST-elevation myocardial infarction. There is no difference. The name ticagrelor keeps reminding me of Excelsior, in Henry Wadsworth Longfellow’s poem of that name:

THE SHADES of night were falling fast,
As through an Alpine village passed
A youth, who bore, ‘mid snow and ice,
A banner with the strange device,
Excelsior! more…

The BMJ Today: You don’t always get what you pay for

15 Sep, 14 | by BMJ

On today, researchers have found that a much cheaper treatment for wet age related macular degeneration causes no more side effects than the far more expensive licensed treatment.

Zosia Kmietowicz reports that the authors of the Cochrane review have found that ranibizumab (Lucentis), which is most commonly used in the UK and costs about £700 an injection, is no more effective than bevacizumab (marketed as Avastin), which costs about £60 an injection. Researchers have previously estimated that using bevacizumab, rather than ranibizumab, could save the NHS £84m a year. more…

Ian Bushfield: Respond to EMA and FDA consultations

12 Sep, 14 | by BMJ

On Monday 15 September, two important consultations (one by the EMA and one by the FDA) will close, ending the public’s opportunity to respond to these consultations and help defend the independent analyses of medical data. The AllTrials campaign has been urging interested parties to respond and have their say on these two consultations, which are outlined below.

Tell the EMA not to censor independent analyses

In Europe, the medicines regulator wants the right to censor analyses of side effects data that it disagrees with. The European Medicines Agency (EMA) is consulting on updates to its EudraVigilance access policy. EudraVigilance is the database where reports of side effects from approved drugs in Europe are recorded. The proposal would give researchers access to more detailed and systematic records from the database, but it also contains a condition that would give the EMA the ability to block publication of analyses it disagreed with. more…

Richard Smith: Simon Stevens, chief executive of NHS England, live

12 Sep, 14 | by BMJ

richard_smith_2014When Simon Stevens, chief executive of NHS England, was buying his Sunday papers a few weeks ago he encountered an elderly woman complaining that her newspaper didn’t contain the television section. It did, as the newsagent pointed out to her before asking her, “Would you like me to walk you home?” Stevens was struck that this was a “dementia friendly community” in action. He followed the story by emphasising that the traditional “factory model of health and social care” will not solve society’s problems, including the rise in dementia. Without a redesign of health and social care services, the NHS will not be sustainable. “We don’t exclusively own the problem or the solution,” he said. more…

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