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Vijaya Nath: Medical engagement—change or die

21 Jul, 14 | by BMJ

vijaya_nathMore than a year since Robert Francis’s recommendations, and after reports by Don BerwickSir Bruce Keogh, and the new Care Quality Commission inspection regime, we are still being challenged to demonstrate that healthcare is first and foremost focused on the needs of the patient.

At the same time, there has been a call for the most expensive assets in healthcare—the doctors—to step up and engage in management and leadership. We use the right words when writing about medical engagement, but how do we move from rhetoric to reality and, more importantly, why should doctors embrace this responsibility? more…

Richard Lehman’s journal review—21 July 2014

21 Jul, 14 | by BMJ

richard_lehmanNEJM 17 July 2014 Vol 371
203  Niacin is an abundant natural B vitamin, which lowers bad cholesterol and raises good cholesterol. What’s not to like? Well, niacin, unfortunately. In doses that make any difference to lipid levels, it is very likely to make you feel sick, get flushes and/or rashes, and/or feel muscle pains. So Merck decided to market it in combination with laropripant, a prostaglandin antagonist that is meant to combat its unpleasant effects. Even so, a third of people who were recruited to the present trial could not continue past the run-in phase with the active combination. And now that the full results are out, we have confirmation that this dual agent definitely does not offer any cardioprotection despite its “favourable” effect on lipids. Worse still it causes bleeding, raises blood sugar, and shows a tendency to increase mortality in those who can tolerate taking it for three years. The Clinical Trials Support Unit (CTSU) at Oxford did a great job of running this trial with funding from Merck, following its usual rules of independence. In doing so, it provides a great illustration of the fact that lipid fractions are very unreliable surrogates for cardiovascular outcomes. But we knew that already, and it seems a great pity to me that many superb researchers were tied down for so long on a project that has made such a small contribution to clinical knowledge, whatever it may have contributed to the funds of CTSU. more…

The BMJ Today: Talking shit again

21 Jul, 14 | by BMJ Group

By the end of next month rural India could have an extra 5.2m toilets as part of a pre-election pledge by Narendra Modi, now prime minister, to build “toilets first and temples later.”

Readers of The BMJ will no doubt be heartened by the Indian government’s announcement, coming seven years after sanitation topped a reader poll as the greatest “medical milestone” in the past 166 years  more…

Readers’ editor: A website needing more soft fruit

20 Jul, 14 | by BMJ Group

davidpayneWe like it when readers take the time and trouble to give us feedback. We’ve been particularly appreciative in the last two weeks as The BMJ’s new website beds down following its launch on 30 June. Some readers responded to the editorial published to mark the new website and the journal’s new name and logo.  Eighty readers replied to an email we sent out about the new site. Others used our customer service feedback form, and contacted us directly via email. Last week we did our first technical release since the new site went live, and we used it to tweak the design (based on your feedback), implement some changes we couldn’t squeeze in before launch, and fix some bugs. more…

Richard Smith: Misunderstanding conflict of interest

18 Jul, 14 | by BMJ

richard_smith2In Britain we have had a row over whether a judge, Elizabeth Butler Sloss, should chair an inquiry into child abuse. Everybody agrees that she has the necessary skills and unquestionable integrity, but she has a conflict of interest: her long dead brother was in the government and may have been involved in covering up child abuse. The case has exposed deep misunderstanding on the nature of conflict of interest.

The country is in the grip of a moral panic over historical cases of child sexual abuse, with well known entertainers going to prison for abuses they committed 50 years ago. Every day we hear rumours of which “national treasure” (a British cliché) will be next. So the government had to react quickly to the possibility that politicians themselves had covered up abuses. In the rush to appoint a chair to the inquiry, the government probably overlooked Butler Sloss’s conflict of interest, and so she was appointed. more…

Tessa Richards: Go with the flow

18 Jul, 14 | by BMJ

Tessa_richardsLegend has it that the Anglo-Saxon king Canute believed his command could hold back the tide. Last week, Financial Times columnist Robert Shrimsley conjured up Canute’s image, as he describes how he went to his GP for a problem and the latter pleaded with him not to go to the internet for information. Of course, the first thing Shrimsley did after leaving the surgery was to search the web, and he says that “‘Don’t google this’ is surely the most forlorn demand since ‘Don’t eat the apple’.”

It’s a great piece. He says cross examination of a doctor was “almost akin to arguing with a priest,” and, tongue in cheek, states it must be “jolly tiresome” for doctors to deal with informed patients; and even more so with “slightly informed ones.” But he urges them to put themselves on “the right side of modernity” and deal with a potentially empowered public. more…

Ike Anya: What can mobile phone polling tell us about population health?

18 Jul, 14 | by BMJ

Ike_Anya-2014One Friday afternoon in May, I sat in my local library in London, surrounded by young men and women, who looked mostly like students studying for examinations. As they buried their heads in their books or scanned their laptop screens, I furiously tapped at the screen on my phone, causing a few heads to look up at me.

My fervid activity was in the cause of answering questions from people in Nigeria about cardiovascular disease and the risk factors associated with it. My tapping was part of #PollingFriday, a weekly Twitter chat that is organised by Nigeria’s first polling organisation, NOIPolls, to publicise the results of their latest polls. Through Twitter, members of the public are encouraged to ask questions about the polling topic, and an expert on said topic is invited to answer their questions. more…

The BMJ Today: Society and healthcare

18 Jul, 14 | by BMJ

jose_merinoRecently, The BMJ published two articles that address important areas of contact between medicine and society. One deals with the best way to deter scientific fraud, the other with potential changes to the healthcare system in Scotland if this nation becomes independent.

On 18 September, Scottish voters will decide whether Scotland will become an independent country. Everyone understands that independence would change many aspects of Scottish life, including how the healthcare system is organized and financed, the medical profession is regulated, drugs are approved, scientific research is supported, and medical education is structured. more…

Alison Cameron: Coming out of the box

17 Jul, 14 | by BMJ

alison_cameronpicI acquired a new label recently. I was named by the Health Service Journal as one of 50 “inspirational women” in healthcare. Quite something for someone who is not in the hierarchy: a “patient” no less.

My work as a patient leader has made me aware of boxes, how we hide in them, and consign others to them. What happens when the labels on the boxes limit us and the lids are firmly closed? more…

Tracey Koehlmoos: Regenerative medicine—where miracles and science overlap

17 Jul, 14 | by BMJ

traceykoehlmoosRegenerative medicine. I did not know it existed until I began working with the Marine Corps. Even writing “regenerative medicine” reminds me that I am not in Bangladesh anymore, trying to produce miracles by scaling up a 20 cent zinc intervention aimed at every child under the age of 5 with diarrhea, or figuring out the best way to get the simplest forms of primary care to the urban homeless, or strengthening access to vaccines. For a health systems scientist, it is a bit of a leap of faith to go into a laboratory that works on the discovery end of the research continuum. more…

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