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The BMJ Today: Helping GPs make better decisions

17 Jul, 14 | by BMJ

tiago_villanuevaAfter being one year out of clinical practice, and working full time in medical editing at The BMJ, I decided to take some time off from work and return this week to the trenches of the healthcare system as a locum GP in my native Portugal, where I remain licensed to practice. I personally feel that it is very important for clinicians who are also professional editors to stay in active clinical practice, even if it’s only to a small extent. I think one job ends up enhancing the other. As editors, we get to easily stay up to date and at the cutting edge of knowledge, but as clinicians, contact with the often complex problems of real patients helps us to more easily identify the learning needs of doctors. more…

Richard Smith: Three myths blocking progress against NCD

16 Jul, 14 | by BMJ

richard_smith2The church at the House of St Barnabas was standing room only to hear Professor Robert Lustig, a paediatric endocrinologist from San Francisco, castigate our current attempts to counter the global pandemic of NCD. (I judge that we’ve reached the stage where NCD, like AIDS, no longer needs to be spelt out.)

Lustig, who has a YouTube video that has been viewed 4.9 million times and who has been interviewed by The BMJ, is clearly somebody who loves his high profile and his capacity to bewitch an audience. Although I’d heard a professor I admire dismiss him as “wholly wrong,” he didn’t encounter much dissent at the meeting organised by C3 Collaborating for Health. He spoke without notes and a PowerPoint presentation, the modern way.

Lustig built his talk around the three myths that he thinks are blocking progress on reducing the burden of NCD. For 30 years, he said, we’ve been concentrating on reducing total calories and fat but made little or no progress. Thinking has been based on bad science. more…

Gitau Mburu: Why communities should care about WHO’s antiretroviral guidelines

16 Jul, 14 | by BMJ

gitau_mburu2014A year ago, the World Health Organization (WHO) issued revised and consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. These guidelines included a key recommendation to initiate HIV treatment earlier (at 500 CD4 cells/mm³ or less) in order to ensure that people with HIV live longer, healthier lives, and to substantially reduce the risk of HIV transmission. If implemented globally, earlier HIV treatment could avert an additional 3m deaths, and prevent 3.5m new HIV infections by 2025.

Getting people on to treatment earlier is now a moral and scientific necessity. However, we know that many communities around the world are already facing tremendous challenges in accessing HIV services. Therefore, reaching a greater number of people who will need treatment even earlier is going to be complex, and will require wholehearted buy in and engagement from affected populations. more…

The BMJ Today: Laws on money and sex

16 Jul, 14 | by BMJ

kristina_fisterBeing a doctor can sometimes feel glamorous. Soon after graduating from medical school, I found myself on a high floor of a fancy hotel in downtown Chicago, waking up to the sun rising over Lake Michigan, a perfect view through a glass wall. Yes, not a window, a wall. Plush carpets, marble bathroom, you know—the works. It was beautiful, and someone else was paying for it.

It might have been at that editorial congress that I learned: disclosure is panacea. Get as many “free lunches” as you want, from whomever you want, but let people to whom it might matter know about it. more…

Shalini: India needs those vaccines

15 Jul, 14 | by BMJ

shaliniIndia has just introduced three new paediatric vaccines to its Universal Immunization Program (UIP), extending protection to its children against deadly and crippling diseases (rotavirus, rubella, and polio through an injectable polio vaccine). With an estimated 27 million children born in India each year, this is an unprecedented policy leap by the new government, which is flexing its muscles. Rotavirus diarrhoea alone costs the country 300 crore rupees (£29m; €37m; $50m) each year in terms of healthcare costs. It also causes 80 000 deaths, and up to a million hospitalizations, in children each year. One episode of rotavirus treatment costs 7-8% of annual income for low income Indian families. The situation couldn’t have been more urgent. more…

The BMJ Today: Explaining telomeres

15 Jul, 14 | by BMJ

georg_roegglaTelomeres are getting a lot of attention at the moment. At the 64th Nobel laureate meeting in Lindau two weeks ago, Elizabeth Blackburn (who won the 2009 Nobel prize in medicine) drew my attention to the role of telomeres in the cellular aging process. more…

Jane Parry: What radiation risk? I’m going to Japan for the clean air

14 Jul, 14 | by BMJ

jane_parry3Chatting to fellow parents about summer holiday plans at a recent school event, I was asked by a mother whether I was worried about radiation levels in Japan. Both her family and mine are travelling to Japan this summer, although neither party are travelling anywhere near Fukushima. I told her that I was actually looking forward to the clean air and getting away from Hong Kong—giving us all a rest from Hong Kong’s hideous air pollution.

She, on the other hand, told me she and her friends were worried about the potential health impact of spending a week in Japan. This is a commonly held view here, and I was reminded of something I learned about risk during my MPH course: it’s not the risk, it’s the risk perception that matters. more…

Jack Johnson: My week as a medical journalist

14 Jul, 14 | by BMJ

jack_johnsonI arrived at the offices of The BMJ on Monday 7 July, expecting to spend the day at a desk reading scholarly articles, which I had little chance of making sense of. I am a sixth form student and spent a week at The BMJ on work experience. My previous encounter with work experience was at Dunn’s Bakery in Crouch End, north London, so I was already impressed as I walked through the reception area of BMA House, and through the courtyard with its fountain and gargoyles. The BMJ’s offices are pretty standard, but it was the world of medical journalism that I was plunged into that really surprised and engaged me. more…

Richard Lehman’s journal review—14 July 2014

14 Jul, 14 | by BMJ

richard_lehmanNEJM 10 July 2014 Vol 371
107  I was very confused by this paper. It describes two trials of three drugs for premenopausal breast cancer with various permutations, and the bottom line is that all the interventions give the same result. Or, if you are a sponsor of the trial, you can report: “In premenopausal women with hormone-receptor–positive early breast cancer, adjuvant treatment with exemestane plus ovarian suppression, as compared with tamoxifen plus ovarian suppression, significantly reduced recurrence.” That is just about true: 88.8% of the women in the tamoxifen group were recurrence-free at five years, compared with 92.8% in the exemestane group, but there was no difference in mortality. This figure was reached by pooling the two trials, though they were not identical. One of them used a variety of means for ovarian suppression and the other only triptorelin. OK, enough of this. If you are a woman with premenopausal breast cancer, demand an option grid to explain the possible adverse effect of these regimens, as well as their minutely different long term benefits. And if you are unhappy at the summary reporting, just think of the bad old days when that might have been framed as a “30.5% reduction in recurrence at five years.” more…

The BMJ Today: Monday’s reflections on alcohol

14 Jul, 14 | by BMJ

wim_weberNothing seems more appropriate on a Monday than to think about the after effects of alcohol. We know that drinking too much is bad for health, but many have always taken comfort in the “fact” that moderate daily intake is associated with a lower cardiovascular risk. The question remains whether light to moderate drinking will actually reduce this risk. Observational studies cannot help us here, but a recent Mendelian randomisation study sheds new light on this controversy. more…

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