Working in supermarkets over the summer holidays can be an education for many an aspiring medical student as, to quote Henry James (and the News of the World newspaper), “all human life is there.” In the supermarket aisles the best and worst aspects of humanity are often laid bare while the checkout assistant struggles to […]
Category: Columnists
Tiago Villanueva: Barbara Starfield’s legacy
Primary healthcare gurus can’t compete with the ranks of top film or sports stars in terms of global notoriety, but Barbara Starfield, who died earlier this month in California aged 78, was one of the most, if not the most, glistening star of the world of academic primary healthcare. She came as close to worldwide celebrity status as a […]
James Raftery: Avastin, Lucentis, and NICE
A useful update was provided at a meeting this week sponsored by the Royal National Institute for the Blind (RNIB) and Patients Involved in NICE (the National Institute for Health and Clinical Excellence). As the proceedings are to be written up and published, I focus here on the key points that emerged for me. […]
Richard Smith: How important are the “early origins of health?”
How important is what happens to you in fetal and neonatal life in determining whether you develop heart disease later in life? I found myself thinking about that question a great deal back in the early 90s when the BMJ published many studies by David Barker, who in 1986 published the “Barker hypothesis” that fetal […]
Muir Gray:”The most effective screening programme ever”
“The most effective screening programme ever,” this was Richard Doll’s gentle jest when I was director of national screening programmes. Aware of my efforts to ensure that screening did much more good than harm, using every improvement technique I could learn from IHI, Toyota, and wherever, he would point out that the auscultation of the […]
Martin McShane: A tale of two citizens?
Four years ago I participated in scenario planning. The document that emerged is as relevant today as it was then – perhaps because it was looking “Over the Horizon,” taking a ten year view and considering plausible alternative futures for health care. We envisaged four scenarios: Fools Gold, Swimming Upstream, Red Arrows, and A Tale […]
David Kerr: The new prohibition
The NHS and technology have had a quixotic sort of relationship recently. A current source of collective angst for the NHS is what to do about social networking? The behemoth of this new genre in communication is Facebook. Facebook and its micro blogging counterpart, Twitter, have even been implicated as major contributors to the recent so-called […]
Richard Smith: Beware journals, especially “top” ones
Dave Sackett, the father of evidence based medicine, used to warn people against reading journals. They took up time that could be better spent and gave you fragments of evidence not the whole picture. This all felt uncomfortable to me when I was editor of the BMJ. […]
Douglas Noble on reforming the reforms
The pause ended in dramatic fashion last week with the publication of the NHS Future Forum’s recommendations. Most interesting was the orthopaedic surgeon at Guys Hospital who confronted the prime minster and deputy prime minister in a rage because the camera crew were not suitably dressed for a hospital. It hit home on all sorts […]
Richard Smith: The NHS debate – missing most of what matters
I’ve stayed out of the NHS debate. These days I spend lots of time in countries like Bangladesh, Kenya, and Guatemala, and viewed from those countries – where health workers and essential drugs are often missing – you wonder why the fuss over the NHS. Everybody has a doctor, primary care is strong, and access to […]