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The BMJ Today: When money and medicine mix

28 Aug, 14 | by BMJ

Anne_GullandEarlier this year, The BMJ published an editorial urging doctors in India to fight back against corruption in medicine. Kickbacks and bribes are a global problem but India, “with rampant corruption at all levels, is prominent in this international field,” the authors wrote.

Since the publication of the editorial in June, the article has been accessed more than 5000 times, but a new feature on thebmj.com by Vidya Krishnan shows how the anticorruption movement is gaining momentum. more…

Lavanya Malhotra: The ice bucket challenge—trivialising trend or canny awareness campaign?

28 Aug, 14 | by BMJ

Lavanya MalhotraLately, social media sites have been invaded by videos of people upending buckets of icy water over their heads. The goal behind this watery exercise is to raise funds, as well as awareness, for amyotrophic lateral sclerosis (ALS) research. The ALS ice bucket challenge is simple: douse yourself in icy water, record it, post it online—on Facebook or Twitter, for instance—including a message about doing it for ALS research, and donate money to the ALS Association (ALSA) through its donation webpage. In the UK, people can donate to the Motor Neurone Disease Association.

The final step is to nominate several friends to do the same. This chain reaction strategy has generated publicity and money for ALSA. So far, 1.7 million people have donated, raising $79.7m (€60.4m; £48m). more…

Paul Teed: Is medical opinion shifting towards support for an assisted dying law?

27 Aug, 14 | by BMJ

Paul TeedOver the weekend, the Times published findings from a new survey conducted by Medix, which asked 600 doctors various questions on assisted dying, assisted suicide, and euthanasia. The coverage contrasted the findings with those from a similar Medix survey a decade ago, reported then in The BMJ. But reading the complete data in the new survey highlights what some would consider surprising, if not shocking, views from doctors, especially when we consider how the medical establishment is often cited as unanimously opposed to any proposals on this issue.

While the majority of doctors were against a UK change in law to allow physician assisted suicide and/or euthanasia when asked the question in broad terms, a majority of respondents also believed that there would be grounds for physician assisted euthanasia if a patient had a terminal illness. more…

The BMJ Today: If wishes were sustainable development goals

27 Aug, 14 | by BMJ

kellyFourteen years ago, leaders from across the world came together at the United Nations headquarters in New York to pledge their efforts towards achieving eight targets for global development. Together, these targets became known as the millennium development goals or MDGs (with three of them directly devoted to a health objective).

Since then, The BMJ, along with other publications and organisations, has scrutinised these goals. We’ve analysed the likelihood of achieving these goals—ruminating on the great challenges they present, and the actions that could advance their attainment. Equally, we’ve flagged up the MDGs’ success stories, such as when the goal for access to safe water was achieved five years early.

More recently, we’ve begun thinking about life after 2015, when the time allotted for the MDGs to do their thing runs out. Last year, Charles Kenny from the Center for Global Development examined the lessons we’ve learnt from the MDGs, and suggestions for the post 2015 development agenda. more…

Jasmin Islam: Ebola readiness—lessons from a district general hospital

26 Aug, 14 | by BMJ

Since the Ebola outbreak was confirmed back in March 2014, I, like many doctors, have been following its progress with a great deal of interest and sadness over the increasing number of deaths, which have included several healthcare workers. In relation to the current outbreak, there have been no confirmed cases of Ebola in the UK and, given increased surveillance and awareness, the risk of importing a case remain low. However, all hospitals should be prepared. more…

The BMJ Today: Ebola, Edinburgh, edifices

26 Aug, 14 | by BMJ

deputy chair of MJA on stage (1)Ebola and the forthcoming referendum on Scottish independence have, among other things, spared UK national newspaper editors the anxiety of how to fill column inches in the “silly season” month of August. The BMJ can at least drop a print and iPad issue, as it is doing this week, but we and other general medical journals are devoting online space to showcase resources about the Ebola outbreak. Visit bmj.com/ebola to find out more. more…

David Zigmond: Can we always “treat” our tragic paradoxes?

22 Aug, 14 | by BMJ

david_zigmond2Robin Williams’s recent death is a familiar shock: another premature loss of a publicly loved figure. How do we understand and respond to such tragic discrepancy?

On the radio (BBC’s Today programme on Radio 4, 15/8/2014) there were lengthy interviews with two publicly accountable experts: the director of long term conditions for NHS England and the president of the Royal College of Psychiatrists. The interviewer asked whether we could “diagnose” and “treat” psychiatric conditions with greater speed and effectiveness—breast lumps were used as an analogy. All three thought that they could comfort one another and the rest of us with assurances: yes, with better science, systems, and training our interception and outcomes are bound to improve. more…

The BMJ Today: Medicine’s vast horizons

22 Aug, 14 | by BMJ

jose_merinoAt first glance, three articles published this week in The BMJ appear to have limited relevance to medicine. One, written by an economist, discusses the challenges faced by demographers when making predictions about population changes; a second deals with international drug control treaties and the need for policy experiments to evaluate the benefits and risks of drug legalization; and a third discusses whether it is ethical to hire sherpas when climbing Mount Everest. more…

Neal Maskrey: Tipping the balance towards individualised care

21 Aug, 14 | by BMJ

neal_maskreyI don’t really get the horror genre. Even as a young boy, the flaky plots and a world working to different rules than the one I was becoming more familiar with every day all seemed laughably improbable. Science takes us incrementally and logically from one discovery to another, building on the shoulders of giants. In the 1960s, in a North Staffordshire mining village existing on the dying embers of the industrial revolution, it seemed to me that Harold Wilson’s white hot technological revolution had more credence than Mary Shelley’s Frankenstein.

Talking of revolutions, two of the great potential revolutions in medicine in the last 30 years have been the formalised teaching of consultation skills and the development of evidence based practice (EBP). I was lucky enough to be a young GP trainer when David Pendleton brought us the first videos of real, live consultations. The memory remains vivid so many years later. more…

The BMJ Today: Working as a GP is often a tall order

21 Aug, 14 | by BMJ

tiago_villanuevaAny GP around the world who’s been in the game long enough is aware that one of the big challenges of the job is to manage patients’ daunting and often unrealistic expectations. In time slots that range from five to 20 minutes—depending on the geographical jurisdiction one is practicing in—GPs do their best to adhere to best clinical practice and to provide quality healthcare under conditions of often great uncertainty and clinical complexity, while at the same time trying to stick to time and avoid litigation. It is often a tall order, and in many countries, GPs are poorly paid and not sufficiently recognised by their peers, society, and politicians for the extremely important work we do.

Recently, two parallel surveys of 1000 GPs and a similar number of patients found that 55% of GPs felt under pressure, particularly from patients, to prescribe antibiotics, even if they were not sure that they were necessary. In the surveys, commissioned by Nesta—the organisation behind the Longitude Prize, which rewards those developing smarter ways of using antibiotics—44% of GPs also admitted that they had prescribed antibiotics to get a patient to leave the practice. What could be seen as even more striking is that about 45% of GPs had prescribed antibiotics for a viral infection, knowing that they would not be effective. more…

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